If you are a health care provider, click below to learn how to apply online or via fax.Apply Now
If you are a patient, click below to learn how to begin your application process.Apply Now
Please Note: At this time, Genentech supports Evrysdi, Nutropin, Cellcept, Valcyte, and Fuzeon through a separate process.Learn more about these support programs
If your practice has a registered account for My Patient Solutions, you can get started by logging into your account.
Log into My Patient Solutions.
Step 2: Complete the online Prescriber Foundation Form.
Both forms are required. No action can be taken until a completed Patient Consent Form and Prescriber Service Form have been received.
The request will be processed within 5 business days upon receipt of both required forms and your office will be contacted to discuss the application outcome and any next steps
Step 2: Once you have completed the Patient Consent form, you can inform your doctor's office and let them know that you are applying for assistance from the Genentech Patient Foundation.
Your doctor will have to complete another form called the Prescriber Foundation Form. Both forms are required. No action can be taken until a completed Patient Consent Form and Prescriber Form have been received.