Polivy

Genentech Patient Foundation Patient Guide: How to Get Polivy (polatuzumab vedotin-piiq) at Low or No Cost

Polivy (polatuzumab vedotin-piiq) is a prescription medicine used in combination with other drugs to treat adults with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), a type of non-Hodgkin lymphoma, after at least two prior therapies.[1][4][7] The Genentech Patient Foundation offers free Polivy to eligible patients who are uninsured, lack coverage for the medicine, or meet specific income criteria after trying other assistance options.[1][2][4]

About Polivy

Polivy is an antibody-drug conjugate that targets cancer cells expressing CD79b, delivering a chemotherapy agent directly to lymphoma cells while sparing healthy ones.[7] It is administered intravenously in a clinical setting, typically every three weeks as part of the Polivy + BR regimen (Polivy with bendamustine and rituximab). Common side effects include low blood cell counts, fatigue, diarrhea, and infusion reactions—discuss risks with your doctor.[7] Always take Polivy as prescribed for FDA-approved uses only.[4]

Who Qualifies?

Eligibility focuses on financial need and insurance status, not U.S. residency alone (though programs prioritize U.S. patients).[1][4] Key groups:

• Uninsured patients or those without coverage for Polivy.
• Insured patients who have tried other assistance (e.g., co-pay programs) but still face high costs, meeting income limits.
• Exclusions: Patients with federal/state government-reimbursed prescriptions (e.g., Medicare Part A/B in certain cases—check specifics).[4][9]

Income Eligibility Breakdown

Specific thresholds aren't publicly fixed; they vary by category and are assessed case-by-case. Insured patients with coverage must exhaust other options first and meet stricter limits; uninsured/underinsured have broader criteria.[1][4] Contact (888) 941-3331 for your situation.[2][9]

Call Foundation Specialists at (888) 941-3331 (Mon-Fri, 6 a.m.–5 p.m. PT) for exact thresholds—they provide personalized guidance.[9]

Insurance Requirements

• Eligible: Uninsured; insured without Polivy coverage; insured who tried other assistance but need help.[4][7]
• Not Eligible: Government-reimbursed prescriptions; must use FDA-approved indications.[4]
• Medicare patients: May qualify if no coverage or after appeals/other options; proof of appeal not required but appeals can run parallel.[9] POLIVY Access Solutions can check coverage, prior authorizations, or appeals first.[7]

Step-by-Step Application Process

Applications are free and use multiple methods (online, fax, text).[2][7] Both forms are required—no action until received.[1][2]

1. Discuss with your doctor: Confirm Polivy prescription and eligibility. Doctor completes Prescriber Foundation Form.[1][2]
2. Complete Patient Consent Form: Sign (English/Spanish available). Available at genentech-access.com or gene.com/patients.[2]
3. Submit together:
   • Online (fastest): Patient does Consent Form; doctor does Prescriber Form via My Patient Solutions or eSubmit.[1][2]
   • Print/Fax: Fax both to 833-999-4363.[2]
   • Text: Photo of signed forms to 650-877-1111.[2]
   • Visit https://www.genentech-access.com or call (888) 941-3331.[1]
4. Processing: Within 5 business days; office contacted with outcome.[2][6]

Tip: Download forms from Genentech sites; Spanish versions available. No extra docs needed—extras delay processing.[7][9]

Timeline and Delivery

• Approval: 5 business days after both forms received.[2][6]
• Reauthorization: Required—reauth every 12 months or per treatment cycle; resubmit forms.[8]
• Delivery: Free Polivy shipped to your home, doctor's office, or participating pharmacy.[Program Details]
• One year of medicine typically provided upon approval.[8]

Alternatives if Denied

• Appeal insurance denial: Use POLIVY Access Solutions for prior auth/appeal help; resources include sample letters, FDA approval info.[1][7]
• Co-pay programs: For commercial/public insurance, get referrals to independent foundations via POLIVY Access Solutions.[4]
• Other options: Specialty pharmacies, state programs, or Genentech Field Reimbursement Manager.[7]
• Reapply: Fix issues (e.g., missing forms) and resubmit; call for guidance.[9]
• No biosimilars available.[Program Details]

Important Disclaimer

This guide is for informational purposes based on available program details as of 2026.[8] Eligibility, benefits, and terms can change; Genentech reserves rights to modify/discontinue.[4] Not a guarantee of approval—contact (888) 941-3331 for latest info. Consult your doctor; Genentech doesn't guarantee coverage/reimbursement.[7] Download brochure at gene.com/patients/patient-foundation.[3] (Word count: 942)