KADCYLA

Indicated For

HER2-positive early breast cancer, HER2-positive metastatic breast cancer

About This Medication

# Genentech KADCYLA Access Solutions Patient Guide: How to Get KADCYLA at Low or No Cost KADCYLA (ado-trastuzumab emtansine) is a targeted therapy for certain types of HER2-positive breast cancer, and Genentech offers financial assistance through **KADCYLA Access Solutions** to help eligible patients reduce or eliminate out-of-pocket costs.[1][2][8] This guide explains eligibility, application steps, and support options for commercially insured patients, those with public insurance, or the uninsured. ## About KADCYLA **KADCYLA** is an intravenous prescription medicine used to treat **HER2-positive early breast cancer** after surgery when cancer remains despite prior neoadjuvant treatment with a taxane and trastuzumab (Herceptin®), or for **HER2-positive metastatic breast cancer** (cancer that has spread) after prior trastuzumab and a taxane.[2][8] It combines trastuzumab (a monoclonal antibody) with emtansine, a chemotherapy agent, delivered directly to cancer cells to minimize damage to healthy tissue. Administered every 3 weeks by a healthcare professional, treatment duration varies based on your doctor's plan and response. Common side effects include fatigue, nausea, low blood cell counts, liver problems, and peripheral neuropathy—discuss risks with your oncologist.[2][9] Genentech does not offer a traditional free patient assistance program (PAP) for unlimited medication supply to uninsured patients. Instead, **KADCYLA Access Solutions** provides **co-pay assistance** for commercial insurance, **referrals to independent foundations**, and limited **free medicine** through the Genentech Patient Foundation for those meeting strict criteria.[1][5][7][10] ## Who Qualifies for Assistance? Eligibility depends on your insurance type, income, age, residency, and prescription use: - **Commercial Insurance (e.g., employer or Marketplace plans):** Primary option via **Genentech Oncology Co-pay Assistance Program**. Covers co-pays, co-insurance, or deductibles up to **$25,000 per year** (resets January 1). Must be 18+, U.S. resident, using KADCYLA for FDA-approved indication. Not for government programs.[2][3][4] - **Public/Government Insurance (Medicare, Medicaid):** Ineligible for co-pay program; get referrals to **independent co-pay foundations**.[1][3][6] - **Uninsured or No Coverage for KADCYLA:** Possible free medicine from **Genentech Patient Foundation** if household adjusted gross income ≤ **$150,000** and other criteria met (e.g., pursued other aid). Different rules for insured without coverage.[1][5][10] - **General Requirements:** Prescription for FDA-approved use; Genentech verifies info and may modify programs.[1][3] **Income Eligibility Breakdown** Genentech programs use **household adjusted gross income** limits rather than strict FPL percentages. No traditional income-based PAP for uninsured, but here's a summary: | Household Size | Max Annual Income (Genentech Patient Foundation) | Notes | |---------------|--------------------------------------------------|-------| | 1 (Individual) | ≤ $150,000 | Uninsured or no coverage; insured must try other aid first [10] | | 2 (Couple) | ≤ $150,000 | Same as above; exact per-size not specified beyond cap [10] | | 3 | ≤ $150,000 | Household AGI; varies by program [10] | | 4+ | ≤ $150,000 | Contact for details; foundations have own rules [1][7] | *Note: Co-pay program has no explicit income limit but other criteria apply. Foundations vary.*[1][10] ## Insurance Requirements - **Eligible:** Primarily **commercial insurance** for co-pay help. Program covers only KADCYLA costs, not office visits or other drugs.[2][3] - **Ineligible:** **Government-funded** (Medicare Part D, Medicaid, VA, Tricare, etc.). Use foundation referrals instead.[1][3][6] - **Uninsured:** Foundation option if income-qualified; otherwise, KADCYLA Access Solutions refers to disease-specific foundations.[1][7][10] ## Step-by-Step Application Process 1. **Talk to Your Doctor:** Confirm KADCYLA prescription and have them complete the **Prescriber Service Form** and **Patient Consent Form**.[6] 2. **Call KADCYLA Access Solutions:** Dial **(888) 249-4918** (6AM-5PM PST, Mon-Fri) for benefits investigation (coverage check), prior authorization help, or program matching.[1][2][7] 3. **For Co-pay Program:** Visit **CopayAssistanceNow.com** or call **(855) MY-COPAY (855-692-6729)** to enroll. Approval often instant; get card for pharmacy/specialty pharmacy use.[3][4] 4. **For Foundation/Free Medicine:** Submit income proof via Access Solutions or Genentech Patient Foundation application.[5][10] 5. **Specialty Pharmacy:** KADCYLA ships via preferred specialty pharmacies; Access Solutions coordinates.[6][7] Reauthorization is required; programs auto-renew annually Jan 1 if eligible, but verify coverage changes.[2] ## Timeline and Delivery - **Co-pay Approval:** Often same-day via phone/online.[3] - **Benefits Investigation/Foundation Referral:** 1-3 business days.[6][7] - **Free Medicine (if approved):** Processing time varies (1-2 weeks typical for similar programs); delivered to doctor's office or specialty pharmacy.[5] - **Delivery:** Direct to provider/specialty pharmacy; patient picks up or home delivers per plan.[6] ## Alternatives if Denied or Ineligible - **Appeal Denial:** Doctor submits appeal with Access Solutions support (sample letters available).[6] - **Foundation Referrals:** Call (888) 249-4918 for lists of independent foundations for breast cancer (e.g., co-pay help).[1][7] - **Other Resources:** Patient Access Network (PAN), HealthWell Foundation, or state programs. Genentech refers but doesn't guarantee.[1] - **No Biosimilars:** None available.[ ] - **Financial Counseling:** Free via Access Solutions in multiple languages.[7] ## Important Disclaimer This guide is for informational purposes based on Genentech programs as of latest data. **Eligibility, benefits, and availability can change.** Programs not valid where prohibited; Genentech reserves rights to verify/deny. **Not a substitute for professional medical/financial advice.** Contact KADCYLA Access Solutions at (888) 249-4918 or your healthcare team. Report side effects to Genentech (1-888-835-2555) or FDA (1-800-FDA-1088).[1][2][9] Always review full **Terms and Conditions** on official sites.[3]

Program information last verified: March 30, 2026