Rozlytrek

Indicated For

solid tumors with NTRK gene fusion, ROS1-positive NSCLC

About This Medication

# Genentech Patient Foundation Patient Guide: How to Get Rozlytrek at Low or No Cost ## About This Program The **Genentech Patient Foundation** is a patient assistance program designed to help eligible patients access Rozlytrek (entrectinib) at no cost or reduced cost. Rozlytrek is a targeted cancer therapy manufactured by Genentech, Inc. This guide explains who qualifies, how to apply, and what to expect throughout the process. ## About Rozlytrek Rozlytrek (entrectinib) is a prescription medication used to treat certain types of cancer. Your doctor has determined that this medication may be appropriate for your treatment. The Genentech Patient Foundation can help you access this medication if you meet eligibility requirements. ## Who Qualifies for the Genentech Patient Foundation? You may be eligible for assistance if you meet one of these criteria: - **Uninsured**: You do not have health insurance coverage - **Underinsured with coverage gaps**: You have health insurance but it does not cover Rozlytrek - **Financial hardship**: You have health insurance, but your out-of-pocket costs for Rozlytrek exceed 7.5% of your household's yearly income - **Income-based eligibility**: Your household income is under $150,000 (specific thresholds vary by family size) **You are not eligible if:** - Your prescription is covered by Medicare, Medicaid, or other government-reimbursed programs - Your insurance plan already covers the medication and you can afford the cost-sharing ## Income Eligibility Breakdown While the Genentech Patient Foundation does not publish strict income cutoffs, eligibility is primarily based on financial need. The program considers: | Factor | Details | |--------|----------| | **Household Income** | Generally under $150,000 annually | | **Out-of-Pocket Costs** | If your insurance requires you to pay more than 7.5% of yearly income for Rozlytrek | | **Household Size** | Income thresholds adjust based on number of people in your household | | **Insurance Status** | Uninsured, underinsured, or unable to afford cost-sharing | For specific income thresholds based on your household size, contact a Foundation Specialist at **(888) 941-3331** (Monday–Friday, 6 a.m.–5 p.m. PT). ## Insurance Requirements The Genentech Patient Foundation can help you regardless of your insurance status: - **If you are uninsured**: You are eligible - **If you have insurance but lack coverage for Rozlytrek**: You are eligible - **If you have insurance that covers Rozlytrek but the cost is unaffordable**: You are eligible if your out-of-pocket maximum exceeds 7.5% of your yearly income - **If you receive government benefits (Medicare, Medicaid, VA, etc.)**: You are generally not eligible for this program, but other assistance options may be available ## Step-by-Step Application Process ### Step 1: Complete the Patient Consent Form You (or your legally authorized representative) must complete the **Patient Consent Form**. This form is available in English and Spanish. **What you'll need to provide:** - Your full name and date of birth - Contact information (phone number and email) - Current address and ZIP code - Insurance status (uninsured, insured but lacking coverage, or insured but medication is unaffordable) - Household size and income information - Authorization for Genentech to contact your insurance company and healthcare providers **Important**: Boxes 1 and 2 of the Patient Consent Form are required. ### Step 2: Have Your Doctor Complete the Prescriber Foundation Form Your healthcare provider must complete **Page 2 of the Prescriber Foundation Form**. Your doctor will provide: - Confirmation that Rozlytrek is medically necessary for your treatment - Your diagnosis code(s) - Whether you have already started therapy - Prescription details and refill information - Preferred shipment method (see "Delivery Options" below) **Note**: Your doctor's office may be able to submit forms online through their registered **My Patient Solutions** account for faster processing. ### Step 3: Submit Both Forms **Both the Patient Consent Form and Prescriber Foundation Form are required.** You have multiple submission options: - **Online submission**: Visit **GenentechPatientFoundation.com** and use eSubmit - **Fax**: Send to **(833) 999-4363** - **Text**: Send a photo of the signed forms to **(650) 877-1111** **Important**: The forms do not have to be submitted together, but both must be received for processing to begin. ## Timeline and What to Expect **Processing Time**: Your application will be processed within **5 business days** of receiving both completed forms. **After Approval**: Once an eligibility determination has been made, both you and your prescriber will be contacted to discuss: - Your application outcome - Next steps for receiving your medication - Any additional information needed **Ongoing Support**: Once enrolled, you will continue to receive free Rozlytrek as long as you remain eligible. **You do not need to reapply each year**—the program will monitor your eligibility status. ## Delivery Options Once approved, you can choose how to receive your medication: - **Upfront Shipments**: Rozlytrek is delivered directly to your home or your doctor's office through the foundation's pharmacy - **Product Replacement**: Your doctor treats you with their own inventory of Rozlytrek, and the foundation reimburses them for the medication ## What If Your Application Is Denied? If you do not qualify for the Genentech Patient Foundation, you have other options: - **Appeal your insurance denial**: If your insurance company denied coverage for Rozlytrek, you and your doctor can file an appeal. You may still apply to the Genentech Patient Foundation while your appeal is pending—you do not need to submit proof of appeal. - **Explore other assistance programs**: Contact a Foundation Specialist to learn about alternative financial assistance options in your area. - **Discuss payment plans**: Ask your doctor's office or pharmacy about payment plans or other resources. ## Getting Help If you have questions at any point in the process, contact a **Foundation Specialist**: - **Phone**: **(888) 941-3331** - **Hours**: Monday–Friday, 6 a.m.–5 p.m. PT - **What they can help with**: Foundation Specialists have local knowledge and can explain eligibility, help you understand your options, and guide you through the application process. You can also visit **Genentech-Access.com** for more information. ## Important Disclaimer This guide provides general information about the Genentech Patient Foundation. Eligibility requirements, program details, and available assistance may change. The information in this guide is current as of March 2026 but should be verified with the program directly. Always consult with your healthcare provider and the Genentech Patient Foundation for the most up-to-date and personalized information about your eligibility and options. This program is intended for patients living in the United States and being treated by a U.S.-licensed physician.

Program information last verified: March 25, 2026