Using the Program

For a physician's office or hospital

• Practice completes a one-time registration by calling (855) MY-COPAY (855-692-6729). (Please note: This registration is for the practice only). At the time of enrollment, we also can:
  • Give you a password for the Provider Portal so you can manage all co-pay patients associated with your practice online
  • Link multiple providers in your practice to your account
• Patient, caregiver or practice applies on behalf of the patient.
• Practice administers infusion.
• Practice faxes a copy of the patient's detailed EOB to (877) 885-2607. Co-pay amount minus the patient out-of-pocket responsibility is loaded onto the card after verification.
• Claims must be submitted within 365 days from the date of service (DOS) for consideration

For providers without a credit card terminal

Before treatment

• Provider confirms patient's enrollment in the program online or by phone at (855) MY-COPAY (855-692-6729).
• Patient downloads the Check Request Form from the Forms section.

After treatment

• Patient completes the Check Request Form and sends it to Genentech, along with copies of the detailed EOB and receipt illustrating payment, via:
  • Fax: (877) 885-2607
  • Mail to:
      Oncology Co-pay Assistance Program
      P.O. Box 2106
      Morristown, NJ 07962
    
• A check is issued to the recipient indicated on the Check Request Form:
  • Check reimbursements take 7 to 10 business days, provided all documentation received is complete
• Claims must be submitted within 365 days from the date of service (DOS) for consideration

For a specialty pharmacy (SP)

• SP completes a one-time registration by calling (855) MY-COPAY (855-692-6729). (Please note: This registration is for the SP only). During this call, we also can provide a password for the Provider Portal so they can manage all co-pay patients associated with their SP online.
• Patient, practice or pharmacy applies on behalf of the patient.
• Practice sends prescription to SP and informs the patient the oral product is being shipped by SP.
• Patient gives the SP the RxBIN, Member ID, Group Number and PCN when SP calls to collect co-pay.
• SP collects the patient's OOP costs using the RxBIN, Member ID, Group Number and PCN.

For a community/retail pharmacy

• Practice completes a one-time registration by calling (855) MY-COPAY (855-692-6729). (Please note: This registration is for the practice only). During this call, we also can give you a password for the Provider Portal so you can manage all co-pay accounts associated with your practice online
• Patient or practice applies on behalf of the patient.
• Practice sends prescription to selected community/retail pharmacy and informs the patient the Genentech Oncology product has been ordered at a community/retail pharmacy.
• Patient brings the RxBIN, Member ID, Group Number and PCN to the community/retail pharmacy to pick up the Genentech Oncology product.
• Community/retail pharmacy collects the patient's OOP cost by using their RxBIN, Member ID, Group Number and PCN.

For SPs or community/retail pharmacies without a credit card terminal

• SP confirms patient's enrollment in the program online or by phone at (855) MY-COPAY (855-692-6729).
• Patient completes the Check Request Form found in the Downloadable Forms section and sends it to Genentech, along with copies of the detailed EOB and receipt illustrating payment, via:
  • Fax: (877) 885-2607
  • Mail to:
      Oncology Co-pay Assistance Program
      P.O. Box 2106
      Morristown, NJ 07962
    
• A check is issued to the recipient indicated on the Check Request Form:
  • Check reimbursements take 7 to 10 business days, provided all documentation received is complete
• Claims must be submitted within 365 days from the date of service (DOS) for consideration