GAVRETO Access Solutions offers a range of access and reimbursement resources for your patients and practice after GAVRETO is prescribed, including help with benefits investigations (BIs), resources for prior authorizations (PAs), sample billing and coding information, resources for denials and appeals, information about distribution and referrals to potential financial assistance options.
Get help understanding insurance benefits and coverage, such as with benefits investigations and prior authorization resources.
GAVRETO Access Solutions can conduct a benefits investigation (BI) which can determine:
*If your patient’s request for a prior authorization is not granted, your GAVRETO Access Solutions Specialist can work with you to determine your next steps.
Get started with enrollment by following the steps below.
Both forms are required. We must have both the Patient Consent Form and the Prescriber Service Form before we can help you.
What to expect next:
Genentech reserves the right to modify or discontinue the program at any time and to verify the accuracy of information submitted.
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and healthcare provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.
Patients facing a coverage delay may be eligible for the SureStart Program while awaiting insurance verification. If you would like your patient considered for the SureStart Program, you can indicate that when enrolling in GAVRETO Access Solutions with the Prescriber Service Form. You will also need to have your patient complete the Patient Consent Form.
Eligible patients can receive a a 30-day supply of GAVRETO. Once coverage has been determined, the patient no longer qualifies for the SureStart Program.
Subject to eligibility requirements and terms and conditions. This program is void where prohibited by law and may not be used in or by residents of restricted states, if applicable.
The GAVRETO SureStart Program provides eligible patients who have experienced an insurance coverage delay of 30 days with one free 30-day supply of GAVRETO. If a coverage delay persists, a patient may be eligible for one 30-day refill of GAVRETO. There is no obligation to purchase any future product and receipt of free product is not contingent on any future purchase. Requests for the GAVRETO SureStart Program cannot be processed without a completed and signed 1) GAVRETO Prescriber Service Form and 2) Patient Consent Form. Patients must be prescribed GAVRETO for an FDA-approved indication. Neither the prescriber, the pharmacy, nor any patient receiving free product via the GAVRETO SureStart Program may seek reimbursement or credit for any part of the benefit received by the patient through this offer from any insurer, health plan, or government program.
The GAVRETO SureStart Program cannot be counted towards any out-of-pocket costs under any plan (such as true out-of-pocket cost under a Medicare Part D prescription drug plan). The GAVRETO SureStart Program enrollment team may notify the patient’s insurer that the patient is receiving a free supply of product from the program. Prescribers may not advertise or otherwise use the program as a means of promoting their services or Genentech’s products to patients. This program is void where prohibited by law and may not be used in or by residents of restricted states, where applicable. The free supply may not be sold, purchased or traded or offered for sale, purchase or trade. This program is not a benefit plan. Genentech reserves the right to rescind, revoke or amend the program without notice at any time.
GAVRETO Access Solutions can help your patients better understand their coverage, find financial assistance options, learn how to get GAVRETO, understand which specialty pharmacy their health insurance plan requires, reverify coverage if needed and enroll in additional support options in the event of a coverage delay.
If the patient’s health insurance plan denies the request for reverification, your practice may file an appeal on behalf of your patient.
Sample coding information and resources for denials and appeals
This coding information may assist you as you complete the payer forms for GAVRETO. These tables are provided for informational purposes only. Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding.
Download sample coding and the important safety information for GAVRETO below.
Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
If your patient’s health insurance plan has issued a denial, your GAVRETO Access Solutions Specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements.
If a plan issues a denial:
A sample appeal letter and additional considerations are available on the Practice Forms and Documents page.
Appeals cannot be completed or submitted by Genentech on your behalf.
My Patient Solutions is an online tool to help you enroll patients in GAVRETO Access Solutions and manage your service requests, all through one portal. It allows you the flexibility to work with GAVRETO Access Solutions when it’s convenient for you.
With My Patient Solutions, you can:
How to register
Account registration can be completed by one person for the entire practice and for multiple practice locations. For help with registration or if you have questions, call us at 877-GENENTECH (877-436-3683) (6AM-5PM PST, Monday through Friday).
GAVRETO Access Solutions works with specialty pharmacies (SPs) to help patients receive their prescribed Genentech medicines.
In addition to distributing medicines, an SP may provide the following services:
You can work with your preferred SP or contact GAVRETO Access Solutions to learn which SP the patient’s health insurance plan mandates or prefers.
Genentech does not influence or advocate the use of any one specialty distributor or specialty pharmacy. We make no representation or guarantee of service or coverage of any item. For any product-specific distribution questions, call GAVRETO Access Solutions at 888-249-4918 (6AM-5PM PST, Monday through Friday).
Learn more about GAVRETO patient financial and practice resources.
Contact your local representative for more information about GAVRETO.
Blueprint Medicines Corporation and Genentech, Inc. are not responsible for any information, statements, or other content you may encounter on third-party websites.