VABYSMO

Indicated For

neovascular (wet) age-related macular degeneration (AMD), diabetic macular edema (DME), macular edema following retinal vein occlusion (RVO)

About This Medication

# Genentech Patient Foundation Patient Guide: How to Get VABYSMO at Low or No Cost ## About This Program The **Genentech Patient Foundation** is a patient assistance program designed to help eligible patients access **VABYSMO (faricimab-svoa)** at no cost or reduced cost. VABYSMO is a Genentech medication used to treat certain eye conditions. If you're struggling to afford your prescription, this program may be able to help. ## Who Can Apply? You may be eligible for the Genentech Patient Foundation if you meet one of these situations: - **Uninsured**: You have no health insurance coverage - **Underinsured**: You have health insurance but cannot afford the out-of-pocket costs for VABYSMO - **Insured with high costs**: Your insurance plan requires you to pay more than 7.5% of your yearly household income for this medication The program is available to patients living in the United States and Puerto Rico who are being treated by a US-licensed physician. We do not collect or require citizenship or immigration information. **Important note**: If your insurance plan requires you to use an AFP vendor or enroll in a Maximizer or Accumulator plan, you may not qualify for Foundation assistance. Contact a Foundation Specialist to discuss your specific situation. ## Income Eligibility Income requirements vary based on your insurance status: | Insurance Status | Income Requirement | |---|---| | **Uninsured** | Household income under $150,000 per year | | **Insured** | Out-of-pocket costs exceed 7.5% of yearly household income | | **Underinsured** | Cannot afford cost-sharing with current insurance | If you're unsure whether you qualify based on income, you can use the Confirm Financial Eligibility form or call a Foundation Specialist at **(888) 941-3331** (Monday–Friday, 6 a.m.–5 p.m. PT) to discuss your situation. Support is available in many languages. ## Insurance Requirements The Genentech Patient Foundation accepts applications from patients with: - **Commercial insurance** (private health plans) - **Public insurance** (Medicare, Medicaid) - **No insurance** (uninsured patients) **Not eligible**: Prescriptions paid for by federal or state government programs are not eligible for this assistance program. ## How to Apply: Step-by-Step ### Step 1: Complete the Patient Consent Form You (or your legally authorized representative) must complete the **Patient Consent Form**, which is available in English and Spanish. This form collects: - Your personal and household information - Your insurance status and coverage details - Your household size and income information - Your authorization for Genentech to process your application ### Step 2: Notify Your Doctor's Office Once you've completed the Patient Consent Form, inform your doctor's office that you're applying for assistance from the Genentech Patient Foundation. ### Step 3: Your Doctor Completes the Prescriber Form Your doctor's office must complete the **Prescriber Foundation Form**. This form confirms: - Your diagnosis and medical need for VABYSMO - Your current prescription details - Your doctor's clinical information **Both forms are required.** Your application cannot be processed without both the completed Patient Consent Form and Prescriber Foundation Form. ### Step 4: Submit Both Forms You or your doctor's office can submit the completed forms using any of these methods: - **Online**: Log into My Patient Solutions (if your practice has a registered account) and submit electronically - **Fax**: Send to **(833) 999-4363** - **Text**: Send a photo of the signed forms to **(650) 877-1111** - **Mail**: Send to the address provided on the forms ## Timeline and What to Expect **Processing time**: Your application will be processed within **5 business days** after both required forms are received. Once a decision is made, both you and your prescriber will be contacted to discuss: - Whether you've been approved - Next steps for receiving your medication - How your medication will be delivered **Medication delivery**: If approved, VABYSMO will be shipped to your physician's office for administration. ## What If You're Denied? If your application is denied, you have options: - **Appeal your insurance decision**: You can apply for Foundation assistance while you and your doctor file an appeal with your insurance company. You do not need to submit proof of appeal with your application. - **Contact a Foundation Specialist**: Call **(888) 941-3331** to discuss why you were denied and explore other assistance options available in your area. - **Explore other programs**: Foundation Specialists have local knowledge and can tell you about other financial assistance programs you may qualify for. ## Reauthorization and Ongoing Coverage If you're approved, you will continue to receive free VABYSMO as long as you remain eligible. **You do not need to reapply each year.** However, your eligibility will be reviewed annually during reverification to ensure you still meet program requirements. ## Important Information - **No proof of appeal required**: You can apply for Foundation assistance while appealing an insurance denial—don't submit extra paperwork, as it may delay processing. - **Language support**: Foundation Specialists are available to help in many different languages. - **Free support**: Call a Foundation Specialist at **(888) 941-3331** anytime during business hours (Monday–Friday, 6 a.m.–5 p.m. PT) if you have questions about eligibility, the application process, or your status. ## Disclaimer This guide provides general information about the Genentech Patient Foundation. Program eligibility, requirements, and benefits are subject to change. For the most current and complete information, visit the official program website or contact a Foundation Specialist directly. This program is intended for patients living in the United States and Puerto Rico being treated by US-licensed physicians.

Program information last verified: March 30, 2026