Is your patient insured?
Does your patient have commercial insurance?What does this mean?
Has your patient already been referred to the Esbriet Co-pay Program and is either ineligible or no longer receiving assistance?
Has your patient already been referred to an independent co-pay assistance foundation and is either ineligible or no longer receiving assistance?
Is the patient taking Esbriet for an approved use?
Is the patient 18 years of age or older?
Your Patient Might Qualify for a Referral to the Esbriet Co-pay Program
If eligible commercially insured patients need assistance with their out-of-pocket costs, Esbriet Access Solutions can refer them to the Esbriet Co-pay Program.*
*In order to be eligible for the Esbriet Co-pay Program, the patient must have commercial insurance, must not have Medicare, Medicaid or other government insurance, and must meet other eligibility criteria. They also must agree to the rules set forth in the terms and conditions for the program. Please visit EsbrietCopay.com for the full list of terms and conditions.
Your Patient Might Qualify for a Referral to an Independent Co-pay Assistance Foundation
For eligible patients with commercial or public health insurance, Esbriet Access Solutions offers referrals to independent co-pay assistance foundations.*
*Genentech does not influence or control the operations or eligibility criteria of any independent co-pay assistance foundation and cannot guarantee co-pay assistance after a referral from Esbriet Access Solutions. The foundations to which we refer patients are not exhaustive or indicative of Genentech’s endorsement or financial support. There may be other foundations to support the patient's disease state.
Your Patient Might Qualify for a Referral to the Genentech® Access to Care Foundation (GATCF)
GATCF helps eligible patients who meet specific criteria receive their Genentech medicine free of charge.*
*To be eligible for free Genentech medicine from GATCF, insured patients must have exhausted all other forms of patient assistance (including the Esbriet Co-pay Program and support from independent co-pay assistance foundations) and meet financial criteria. Uninsured patients must meet different financial criteria.
DOES YOUR PATIENT HAVE COMMERCIAL INSURANCE?
Esbriet Access Solutions can refer eligible patients to the Esbriet Co-pay Card* for help with the out-of-pocket (OOP) costs associated with Esbriet
DOES YOUR PATIENT HAVE INSURANCE?
If eligible publicly or commercially insured patients have difficulty paying for their co-pay, co-insurance, or other OOP costs, Esbriet Access Solutions can refer them to an independent co-pay assistance foundation supporting their disease state†
IS YOUR PATIENT UNINSURED OR UNDERINSURED?
Genentech® Access to Care Foundation (GATCF) provides free medicine to eligible patients who are uninsured, rendered uninsured by payer denial, or underinsured. To qualify, patients must meet financial criteria‡