Apply to Genentech Patient Foundation

Free Genentech medicine for people without insurance, or whose insurance denied the drug or leaves costs they cannot afford, who meet income limits. Apply directly with the program; here is what it asks and what happens next.

Who can apply?

Uninsured: household adjusted gross income under $150,000 a year (households up to 4), plus $25,000 for each person beyond four. Not FPL-based (about 940% FPL for 1, 455% for 4). Insured with high out-of-pocket costs: 'certain income requirements', not published.

Uninsured: household adjusted gross income under $150,000 a year (households up to 4), plus $25,000 for each person beyond four. Not FPL-based (about 940% FPL for 1, 455% for 4). Insured with high out-of-pocket costs: 'certain income requirements', not published.

Three groups: uninsured (income under $150,000); insured but coverage denied (not on formulary or plan restriction; can apply during appeal; plans requiring a step edit may make patient ineligible); insured with high out-of-pocket costs (must try copay programs or independent foundations first, and meet income requirements). Medicare, Medicaid and VA are not addressed separately on the pages read. New or re-applying patients whose plans use alternate funding programs, copay maximizers or copay accumulators are not eligible; plans that require PAP enrollment as a condition of coverage also exclude.

Not for people whose employer or plan sends them to the program as a condition of coverage.

Then what?

  1. Sign

    • Patient Consent Form (online or PDF; patient or legal representative)

  2. Attach

    • income verification as requested (call a Foundation Specialist)

  3. Your prescriber

    • completes the Prescriber Foundation Form (online, or printed and faxed or texted as a photo to 650-877-1111)
    • orders medicine by phone, Prescriber Foundation Form or Product Replacement Form

  4. Send

    • Fax 1-833-999-4363

Rather apply online? Apply on the Genentech Patient Foundation site.

Questions: call Genentech Patient Foundation at 1-888-941-3331. Stays enrolled while eligible; eligibility rechecked at annual reverification..

Free. EveryCard Rx isn't paid by the program and never sends anything for you. Form , rules checked 2026-11-06 from the program's own pages. Something out of date? Tell us.