For US Healthcare Professionals

Use our Patient Assistance Tool to find out which assistance option might be right for you

There may be options to help you afford your POLIVY, no matter what type of health insurance you have.

  • Do you have health insurance?

  • Does your health insurance cover your Genentech medicine?

  • Do you have commercial health insurance?

  • Are you already getting financial assistance to help pay for your medicine?

  • Are you 18 years of age or older?

You Might Qualify for a Referral to the Genentech Oncology Co-pay Assistance Program

POLIVY Access Solutions can refer you to the Genentech Oncology Co-pay Assistance Program. It can help you with the out-of-pocket costs of your Genentech medicine, if you’re eligible.*

 

Learn More

 

*Eligibility criteria apply. Not valid for patients using federal or state government programs to pay for their medications and or administration of their Genentech medication. Patient must be taking the Genentech medication for an FDA-approved indication. See full Terms and Conditions at CopayAssistanceNow.com.

You Might Qualify for a Referral to an Independent Co-pay Assistance Foundation

If you need help with your co-pay for your Genentech medicine, we can refer you to an independent co-pay assistance foundation.*

 

Learn More

 

*Independent co-pay assistance foundations have their own rules for eligibility. We cannot guarantee a foundation will help you. We only can refer you to a foundation that supports your disease state. We do not endorse or show financial preference for any particular foundation. The foundations we refer you to are not the only ones that might be able to help you.

You Might Qualify for a Referral to the Genentech Patient Foundation

The Genentech Patient Foundation provides free Genentech medicine to people who don't have insurance coverage or who have financial concerns and to people who meet certain income criteria.*

 

Learn More

 

*If you have health insurance, you should try to get other types of financial assistance, if available. You also need to meet income requirements. If you do not have insurance, or if your insurance does not cover your Genentech medicine, you must meet a different set of income requirements.

Genentech Oncology Co-pay Programs*

Genentech co-pay programs help people with commercial health insurance. This might be a plan you get through your employer or one you purchased through a Health Insurance Marketplace like HealthCare.gov. To qualify, you must also meet other criteria.

Learn More

Independent Co-pay Assistance Foundations†

If you need help with the co-pay for your Genentech medicine, Genentech Access Solutions can refer you to an independent co-pay assistance foundation. Independent co-pay assistance foundations help patients with public or commercial health insurance.

See How We Can Help

Genentech Patient Foundation‡

The Genentech Patient Foundation gives free Genentech medicine to people who don’t have insurance coverage or who have financial concerns and meet eligibility criteria.

Are You Eligible?

*This Genentech Oncology Co-pay Program is valid ONLY for patients with commercial insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid, or any other federal or state government program to pay for their medications are not eligible.
Under the Program, the patient will pay a co-pay. After reaching the maximum Program benefit, the patient will be responsible for all out-of-pocket costs.
All participants are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. No party may seek reimbursement for all or any part of the benefit received through this Program. This Program is void where prohibited by law. Genentech reserves the right to rescind, revoke, or amend the Program without notice at any time. Additional eligibility criteria apply. See full terms and conditions at CopayAssistanceNow.com.
†Independent co-pay assistance foundations have their own rules for eligibility. We cannot guarantee a foundation will help you. We can only refer you to a foundation that supports your disease state. This information is provided as a resource for you. We do not endorse or show financial preference for any particular foundation. The foundations in this list are not the only ones that might be able to help you.
‡To be eligible for free Genentech medicine from the Genentech Patient Foundation, insured patients who have coverage for their medicine must have pursued all other forms of financial assistance and meet certain income requirements. Uninsured patients and insured patients without coverage for their medicine must meet different income requirements.

Genentech Access Solutions is a program that helps people who are taking a Genentech medicine. We know how important it is for you to get the Genentech medicine your doctor prescribed. We are here to help.

Learn how we help.

Our Patient Assistance Tool helps you find out which of our financial assistance options may work for you. Answer a few questions to learn which options you might qualify for.

With some programs, you might have to state your household income. You can learn more about each option and its criteria at Genentech-Access.com.

To enroll in Genentech patient support services, simply fill out the Patient Consent Form. Your doctor will have to fill out a separate form, called the Prescriber Service Form. We can begin helping you once we receive both forms. You can find the Patient Consent Form at Genentech-Access.com/PatientConsent or your doctor might give it to you.

Each program has its own time period for you to receive assistance. You can call us at (888) 249-4918 for more information.

To learn how we can help:

Indication

POLIVY is a prescription medicine used with other medicines, bendamustine and a rituximab product, to treat diffuse large B-cell lymphoma in adults who have progressed after at least 2 prior therapies.

The conditional approval of POLIVY is based on a type of response rate. There are ongoing studies to establish how well the drug works.

Possible serious side effects

Everyone reacts differently to POLIVY therapy, so it’s important to know what the side effects are. Some people who have been treated with POLIVY have experienced serious to fatal side effects. Your doctor may stop or adjust your treatment if any serious side effects occur. Be sure to contact your healthcare team if there are any signs of these side effects.

  • Nerve problems in your arms and legs: This may happen as early as after your first dose and may worsen with every dose. Your doctor will monitor for signs and symptoms, such as changes in your sense of touch, numbness or tingling in your hands or feet, nerve pain, burning sensation, any muscle weakness, or changes to your walking pattern
  • Infusion-related reactions: You may experience fever, chills, rash, breathing problems, low blood pressure, or hives within 24 hours of your infusion
  • Infections: If you have a fever of 100.4°F (38°C) or higher, chills, cough, or pain during urination, contact your healthcare team. Your doctor may also give you medication before giving you POLIVY, which may prevent some infections, and will monitor your blood counts throughout treatment with POLIVY. Treatment with POLIVY can cause severe low blood cell counts
  • Rare and serious brain infections: Your doctor will monitor closely for signs and symptoms of these types of infections. Contact your doctor if you experience confusion, dizziness or loss of balance, trouble talking or walking, or vision changes
  • Tumor lysis syndrome: Caused by the fast breakdown of cancer cells. Signs include nausea, vomiting, diarrhea, and lack of energy
  • Potential harm to liver: Some signs include tiredness, weight loss, pain in the abdomen, dark urine, and yellowing of your skin or the white part of your eyes. You may be at higher risk if you already had liver problems or you are taking other medication

Side effects seen most often

The most common side effects during treatment were

  • Low blood cell counts (platelets, red blood cells, white blood cells)
  • Nerve problems in arms and legs
  • Tiredness or lack of energy
  • Diarrhea
  • Nausea
  • Fever
  • Decreased appetite
  • Infections

POLIVY may not be for everyone. Talk to your doctor if you are

  • Pregnant or think you are pregnant: Data have shown that POLIVY may harm your unborn baby
  • Planning to become pregnant: Women should avoid getting pregnant while taking POLIVY. Women should use effective contraception during treatment and for at least 3 months after their last POLIVY treatment. Men taking POLIVY should use effective contraception during treatment and for at least 5 months after their last POLIVY treatment
  • Breastfeeding: Women should not breastfeed while taking POLIVY and for at least 2 months after the last dose

These may not be all the side effects. Talk to your healthcare provider for more information about the benefits and risks of POLIVY treatment.

You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.

Please see the full Prescribing Information for additional Important Safety Information.

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