Coverage and Reimbursement Support

Tarceva^® Access Solutions™

When seeking coverage and reimbursement help from Tarceva Access Solutions, there are 2 forms you and your doctor will need to complete:

Statement of Medical Necessity (SMN) form — a form filled out by your doctor.
The Patient Authorization and Notice of Release of Information (PAN) form — a form you must sign and date. This form gives us written permission to discuss your case with you, your health care provider and your health insurance plan.
- Download the PDF (1MB)

When you or your doctor's office calls Tarceva Access Solutions, we will connect you with one of our dedicated Specialists whose only job is to work with you to get the help you need to cover the cost of your medicine.

Tarceva Access Solutions Specialists look at what you may need to know about your health insurance plan's coverage and issues that may affect reimbursement for use of our medicines.

You may have a private health insurance plan or be covered by Medicare or Medicaid. We can help you with issues that include:

What your health insurance plan really covers (known as "benefits investigation")
Whether your insurer must approve use of a specific Genentech medicine before your treatment begins (known as "prior authorization")
What happens if the insurer decides you are not covered for a specific Genentech medicine (known as "denial," which can be appealed)

To speak live with one of our Specialists, call (888) 249-4918 from 6 a.m. – 5 p.m. PT, Monday to Friday, fax (888) 249-4919 or visit TarcevaAccessSolutions.com

Genentech Access to Care Foundation (GATCF)

The Genentech Access to Care Foundation (GATCF) helps patients who do not have insurance coverage for a Genentech medicine. Qualified patients enrolled in GATCF receive their medicine free of charge.

We are committed to helping you get our medicines regardless of your ability to pay
If you have no insurance, or your health insurance plan denies you coverage for Tarceva, you can work with your doctor's office to apply to GATCF for free medicine

To speak live with one of our Specialists, call (800) 530-3083 from 6 a.m. – 5 p.m. PT, Monday to Friday, fax (877) 428-2326 or visit TarcevaAccessSolutions.com

Indication and Usage for Advanced Pancreatic Cancer Patients

Tarceva in combination with gemcitabine is prescribed for patients with advanced-stage pancreatic cancer who have not received previous chemotherapy.

Important Safety Information

Possible effects on the lungs

In clinical studies, there were infrequent reports of lung injuries similar to Interstitial Lung Disease (ILD)-like events in patients taking Tarceva for the treatment of pancreatic cancer or other advanced solid tumors. Reports of these ILD-like lung injuries have been serious and have included deaths in some patients.

Possible effects on the kidneys and liver

Liver and/or kidney problems (including deaths) have been reported in some patients taking Tarceva. Let your doctor know if you have a history of liver or kidney disease.

Possible effects on the stomach and intestines

Holes that formed in the stomach, small intestine, or large bowel (including deaths) have been reported in patients taking Tarceva.

Possible effects on the skin

Severe blistering skin reactions including cases similar to Stevens-Johnson syndrome (including deaths) have been reported in patients taking Tarceva.

Possible effects on the veins and heart

Patients taking Tarceva plus gemcitabine were more likely to experience bleeding and clotting problems such as heart attack or stroke.

Possible effects on the eye

Eye irritation and damage to the cornea have been reported in patients taking Tarceva. Patients should tell their doctor about eye problems, including eye pain, that get worse.

Tarceva and pregnancy and breast-feeding

Tarceva may cause harm to an unborn baby or may cause possible risk of pregnancy loss. Women should avoid becoming pregnant and avoid breastfeeding while taking Tarceva.

When to call your HCP

Call your doctor right away if you have these signs or symptoms:

New or worsening skin rash
Serious or ongoing diarrhea, nausea, loss of appetite, vomiting, or stomach pain
New or worsening shortness of breath or cough
Fever
Eye irritation

If you smoke, you should stop smoking while taking Tarceva, as it may affect how well Tarceva works for you. If you continue to smoke you should speak to your doctor before taking Tarceva.

Let your doctor know if you are taking other prescription or over-the-counter drugs or herbal supplements before you start taking Tarceva. While taking Tarceva, do not start taking any new drugs or herbal supplements before talking to your doctor. Do not eat grapefruit or drink grapefruit juice while taking Tarceva. Tarceva may also affect other medications you are taking.

Common side effects of Tarceva

Fatigue, rash, nausea, loss of appetite, and diarrhea were the most common side effects associated with Tarceva plus gemcitabine therapy in a large clinical study.

Always let your doctor or nurse know if you experience any side effects. Ask your doctor or nurse for the best way to handle drug-related side effects.

Tarceva is not right for everyone. Ask your doctor if once-daily Tarceva is right for you.

Please see the Tarceva full prescribing information for complete safety information.

Tarceva^® and its logo are trademarks of OSI pharmaceuticals, Inc.
The Access Solutions logo and the Access Solutions Treatment made possible logo are trademarks of Genentech, Inc.