Knowing what to expect can make all the difference. We can help you through each step of getting your Genentech medicine.
Knowing what to expect can make all the difference. We can help you through each step of getting your Genentech medicine.
Knowing what to expect can make all the difference. We can help you through each step of getting your Genentech medicine.
PiaSky Access Solutions is a resource for people who take a Genentech medicine. We connect you to the medicine you have been prescribed.
Genentech is the company that makes PiaSky. We believe every person should get the Genentech medicine their doctor prescribed and we offer programs to help make this happen.
There may be options to help you get the Genentech medicine your doctor has prescribed. PiaSky Access Solutions can refer you to financial assistance options.
You can’t get your Genentech medicine from your local pharmacy. Instead, it will come to you from a specialty pharmacy.
Your specialty pharmacy is different from your regular mail-order pharmacy. It handles drugs like PiaSky.
When we check your coverage, we also refer you to a specialty pharmacy your health insurance plan will cover.
You might not be able to get your Genentech medicine right away. First, your doctor's office, specialty pharmacy, treatment center pharmacy or hospital pharmacy will have to check to make sure your health insurance plan covers your medicine. This is called a “benefits investigation.” They also might have to send some more information before your plan covers your medicine. This is called a “prior authorization.”
There are 3 ways to send us the Patient Consent Form:
The Patient Consent Form gives us permission to discuss your health information with others, such as your doctor and your health insurance plan, so we can perform our services. We can’t work with you without a signed Patient Consent Form.
You do not need to do anything else, but your doctor does. He or she needs to submit the Prescriber Service Form. This form tells us your doctor wants to treat you with PiaSky. Make sure your doctor has sent us the Prescriber Service Form so you get help from us.
You do not need to fill out anything on the Prescriber Service Form.
If your health insurance plan will not cover your Genentech medicine, you and your doctor’s office can file an appeal. Contact your doctor to ask if you should file an appeal.
We have resources to help you and your doctor file an appeal.
PiaSky Access Solutions cannot complete or submit an appeal for you.
We have resources to help you and your doctor file an appeal. You or your doctor’s office has to file the appeal directly with your health insurance plan.
PiaSky Access Solutions cannot complete or submit an appeal for you.
This depends on your health insurance plan. You should ask your plan directly about its process. Sometimes the appeals process is quick. However, it can take several months if you have to appeal several times.
PiaSky Access Solutions cannot complete or submit an appeal for you.
If your insurance changes while you’re taking your Genentech medicine, call us. We can help you understand your new coverage.
The Genentech Patient Foundation gives free Genentech medicine to people who don’t have health insurance coverage or who have financial concerns and meet certain eligibility criteria.
You and your doctor are responsible for completing and submitting all required paperwork to your health insurance plan. Genentech cannot guarantee your plan will cover any treatments.
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Terms and Conditions
The Co-pay Program (“Program”) is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medicine. Patients using Medicare, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government program (collectively, “Government Programs”) to pay for their Genentech medicine are not eligible. The Program is not valid for Genentech medicines that are eligible to be reimbursed in their entirety by private insurance plans or other programs.
Under the Program, the patient may be required to pay a co-pay. The final amount owed by a patient may be as little as $0 for the Genentech medicine (see Program specific details available at the Program Website). The total patient out-of-pocket cost is dependent on the patient’s health insurance plan. The Program assists with the cost of the Genentech medicine only. It does not assist with the cost of other medicines, procedures or office visit fees. After reaching the maximum annual Program benefit amount, the patient will be responsible for all remaining out-of-pocket expenses. The Program benefit amount cannot exceed the patient’s out-of-pocket expenses for the Genentech medicine. The maximum Program benefit will reset every January 1st. The Program is not health insurance or a benefit plan. The patient’s non- governmental insurance is the primary payer. The Program does not obligate the use of any specific medicine or provider. Patients receiving assistance from charitable free medicine programs (such as the Genentech Patient Foundation) or any other charitable organizations for the same expenses covered by the Program are not eligible. The Program benefit cannot be combined with any other rebate, free trial or other offer for the Genentech medicine. No party may seek reimbursement for all or any part of the benefit received through the Program.
The Program may be accepted by participating pharmacies, physicians’ offices or hospitals. Once a patient is enrolled, the Program will honor claims with a date of service that precedes the Program enrollment date up to 180 days. Claims must be submitted within 365 days from the date of service unless otherwise indicated. Use of the Program must be consistent with all relevant health insurance requirements. Participating patients, pharmacies, physicians’ offices and hospitals are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. Programs’ benefits may not be sold, purchased, traded or offered for sale.
The patient or their guardian must be 18 years of age or older to receive Program assistance. The Program is only valid in the United States and U.S. Territories, is void where prohibited by law and shall follow state restrictions in relation to AB-rated generic equivalents (e.g., MA, CA) where applicable. Eligible patients will be automatically re-enrolled in the Program on an annual basis. Eligible patients will be removed from the Program after 3 years of inactivity (e.g., no claims submitted in a 3-year timeframe). Program eligibility and automatic re enrollment are contingent upon the patient’s ability to meet all requirements set forth by the Program. Healthcare providers may not advertise or otherwise use the Program as a means of promoting their services or Genentech medicines to patients.
The value of the Program is intended exclusively for the benefit of the patient. The funds made available through the Program may only be used to reduce the out-of-pocket costs for the patient enrolled in the Program. The Program is not intended for the benefit of third parties, including without limitation third party payers, pharmacy benefit managers, or their agents. If Genentech determines that a third party has implemented a program that adjusts patient cost-sharing obligations based on the availability of support under the Program and/or excludes the assistance provided under the Program from counting towards the patient’s deductible or out-of-pocket cost limitations, Genentech may impose a per fill cap on the cost-sharing assistance available under the Program. Submission of true and accurate information is a requirement for eligibility and Genentech reserves the right to disqualify patients who do not comply from Genentech programs. Genentech reserves the right to rescind, revoke or amend the Program without notice at any time.
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