GENENTECH, INC.

Genentech, Inc. offers Genentech Access Solutions—a resource for access and reimbursement support after a Genentech medicine is prescribed.

For more information, search the prescribed Genentech product in this Guide, go online, or call 888.249.4918, Monday through Friday, 6:00 AM to 5:00 PM PST.

Oncology-related products: Alecensa^® (alectinib) capsules, Avastin^® (bevacizumab) injection for IV use, COLUMVI™ (glofitamab-gxbm) injection for intravenous use, Cotellic^® (cobimetinib) tablets, Erivedge^® (vismodegib) capsules, Gazyva^® (obinutuzumab) injection, Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk) injection, Herceptin^® (trastuzumab) injection for intravenous use, Kadcyla^® (ado-trastuzumab emtansine) injection for intravenous use, LUNSUMIO™ (mosunetuzumab-axgb) injection for intravenous use, Perjeta^® (pertuzumab) for injection, Phesgo™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) subcutaneous injection, Polivy^® (polatuzumab vedotin-piiq) injection for intravenous use, Rituxan Hycela^® (rituximab and hyaluronidase human) injection for subcutaneous use, Rituxan^® (rituximab) injection for intravenous use, Rozlytrek^® (entrectinib) capsules, Tecentriq^® (atezolizumab) injection for intravenous use, Venclexta^® (venetoclax) tablets, Zelboraf^® (vemurafenib) tablets

Reimbursement Assistance

Genentech Oncology Access Solutions

Benefits Investigation

Genentech Access Solutions can conduct a benefits investigation to help determine if a Genentech medicine is covered, if prior authorizations are required, which specialty pharmacy the health insurance plan prefers, and if patient assistance might be needed. The potential outcomes of a benefits investigation are:

• Treatment is covered
• Prior authorization is required
• Treatment is denied.

Both the Prescriber Service Form and the Patient Consent Form must be received before Genentech Access Solutions can begin helping patients.

Forms can be found by going to genentech-access.com, selecting the prescribed medication, and selecting the “Forms and Documents” option. The forms can be submitted via fax to the number listed on it or online via My Patient Solutions.

Prior Authorization Assistance

Genentech Access Solutions can help identify if a prior authorization is necessary and offer resources as healthcare professionals obtain it for patients. Both the Prescriber Service Form and the Patient Consent Form must be received before Genentech Access Solutions can begin helping patients. If the request for a prior authorization is not granted, a field reimbursement manager or Genentech Access Solutions specialist can work with healthcare professionals to determine next steps.

Forms can be found by going to genentech-access.com, selecting the prescribed medication, and selecting the “Forms and Documents” option. The forms can be submitted via fax to the number listed on it or online via My Patient Solutions.

Appeals

If a patient’s health insurance plan has issued a denial, a field reimbursement manager or Access Solutions specialist can provide resources as healthcare professionals prepare an appeal submission, as per the patient’s plan requirements. If a plan issues a denial:

• The denial should be reviewed, along with the health insurance plan’s guidelines, to determine what to include in the patient’s appeal submission
• A field reimbursement manager or Genentech Access Solutions specialist has local payer coverage expertise and can help determine specific requirements for the patient.

Sample appeal letters and additional considerations are available at genentech-access.com by selecting the prescribed medication and choosing the “Forms and Documents” section. Appeals cannot be completed or submitted by Genentech Access Solutions on a healthcare provider's behalf.

My Patient Solutions

My Patient Solutions is an online tool to help enroll patients in Genentech Access Solutions and manage service requests. Log in or register with My Patient Solutions to:

• Enroll and re-enroll patients
• Communicate with a Genentech Access Solutions specialist
• See which service requests require action
• Co-pay assistance details
• View Genentech Patient Foundation eligibility and coordinate shipments
• View benefits investigation reports
• Follow up on prior authorizations or appeals
• Request benefits reverifications.

Account registration can be completed by one person for an entire practice and for multiple practice locations online. For assistance, call 888.249.4918, Monday through Friday, 6:00 AM to 5:00 PM PST.

Independent Charitable Foundations/Organizations

Genentech Oncology Access Solutions Referrals

An independent co-pay assistance foundation is a charitable organization providing financial assistance to patients with specific disease states. Genentech Access Solutions offers referrals to independent co-pay assistance foundations for eligible patients who are commercially or publicly insured, including those covered by Medicare and Medicaid.

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 Genentech Access Solutions.

For more information, visit genentech-access.com, select the prescribed medication, and select "Find Patient Assistance."

For further assistance, call 888.249.4918, 6:00 AM to 5:00 PM PST, Monday through Friday.

Co-Pay Card/Out-Of-Pocket Cost Assistance

Genentech Oncology Co-Pay Assistance Program

Genentech offers the Oncology Co-Pay Assistance Program to help eligible patients pay for prescription medication costs. In order to qualify for the program, patients must meet the following criteria:

• Be covered by commercial (also known as private) insurance
• Receive a Genentech Oncology product for an FDA-approved indication
• Not participate in a federal or state-funded healthcare program, including but not limited to Medicare, Medicaid, VA, DoD, TriCare, and Medigap
• Be 18 years of age or older, or they have a legal guardian 18 years of age or older to manage the program
• Live in and receive treatment in the United States or U.S. territories
• Not be receiving assistance through the Genentech Patient Foundation or any other co-pay charitable organization.

There are no income requirements. Patients pay as little as $5 for their prescribed Genentech oncology product(s), subject to an annual benefit limit of $25,000 per product. The $5 co-pay applies to FDA-approved Genentech combination products.

Retroactive requests for assistance may be honored for qualifying patients if the infusion or prescription fill occurred within 180 days prior to enrollment and the patient meets all eligibility criteria at the time of infusion. No physical card is needed; patients simply need their Member ID.

To get started, visit copayassistancenow.com. For questions about this program, call 855.692.6729, Monday through Friday, 9:00 AM to 8:00 PM EST.

Patient Assistance Program

Genentech Patient Foundation

The Genentech Patient Foundation provides free Genentech medicine to people who don’t have insurance coverage or who have financial concerns. Patients qualify if they:

• Are uninsured with incomes under $150,000
• Are insured without coverage for a Genentech medicine with incomes under $150,000
• Are insured with coverage for a Genentech medicine, with unaffordable out-of-pocket costs, who have pursued other forms of financial assistance, and who have a household size and income within certain guidelines (Guidelines are available online).

If one of these situations applies, fax the completed enrollment forms to 833.999.4363 or submit them online. The request will be processed within five business days upon receipt of the required forms, and the healthcare provider's office will be contacted to discuss the application outcome and any next steps.

For more information, call 888.941.3331, Monday through Friday, 6:00 AM to 5:00 PM PST.