ACTEMRA Access Solutions offers a range of access and reimbursement resources for your patients and practice after ACTEMRA is prescribed, including help with benefits investigations (BIs), resources for prior authorizations (PAs), sample billing and coding information, resources for denials and appeals, information about distribution and referrals to potential financial assistance options.
Get help understanding insurance benefits and coverage, such as with benefits investigations and prior authorization resources.
ACTEMRA Access Solutions can conduct a benefits investigation (BI) which can determine:
*If your patient’s request for a prior authorization is not granted, your ACTEMRA Access Solutions specialist can work with you to determine your next steps.
Get started with enrollment by following the steps below.
If your practice has a registered account for My Patient Solutions, you can get started by logging into your account.
Don't have an account?
Your patient is required to complete the Patient Consent Form. You can either upload their Patient Consent Form as part of your application or have your patient submit the form via fax, text or e-submit.
An online tool to help you enroll patients in ACTEMRA Access Solutions and manage your service requests at your convenience.
Step 1: Print one of the Patient Consent Forms below for your patient to complete.
Step 2: Print and complete the Prescriber Service Form below.
Step 3: Submit the completed forms via fax or text.
Both forms are required. We must have both the Patient Consent Form and the Prescriber Service Form before we can help you.
What to expect next:
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and healthcare provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.
Sample coding information and resources for denials and appeals
This coding information may assist you as you complete the payer forms for ACTEMRA. These tables are provided for informational purposes only. Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding.
Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
If your patient’s health insurance plan has issued a denial, your ACTEMRA Access Solutions specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements.
If a plan issues a denial:
A sample appeal letter and additional considerations are available on the Practice Forms & Documents page.
Appeals cannot be completed or submitted by Genentech on your behalf.
My Patient Solutions is an online tool to help you enroll patients in ACTEMRA Access Solutions and manage your service requests, all through one portal. It allows you the flexibility to work with ACTEMRA Access Solutions when it’s convenient for you.
With My Patient Solutions, you can:
How to register
Account registration can be completed by one person for the entire practice and for multiple practice locations. For help with registration or if you have questions, call us at 877-GENENTECH (877-436-3683) (6AM-5PM PST, Monday through Friday).
Genentech has contracted with authorized specialty distributors and specialty pharmacies (SPs) to service practices choosing to prescribe ACTEMRA.
These partners have made a commitment to product integrity and have agreed to distribute only products purchased directly from Genentech and not to distribute ACTEMRA through secondary channels.
For a full list of authorized distributors, please visit the Genentech Access Solutions website or contact ACTEMRA Access Solutions at 1-800-ACTEMRA (1-800-228-3672).
With Buy and Bill, the practice purchases the medication in advance, then bills the patient's health insurance plan for reimbursement. The practice is responsible for storing and handling the drug as well as collecting the patient's co-pay for both the drug and its administration. With Buy and Bill, practices can maintain a stock of the drug, giving them the flexibility to treat patients when clinically appropriate.
ACTEMRA Access Solutions works with specialty pharmacies (SPs) to help patients receive their prescribed Genentech medicines.
In addition to distributing medicines, an SP may provide the following services:
You can work with your preferred SP or contact ACTEMRA Access Solutions to learn which SP the patient’s health insurance plan mandates or prefers.
For a full list of in-network specialty pharmacies, please visit the Genentech Access Solutions website or contact ACTEMRA Access Solutions at 1-800-ACTEMRA (1-800-228-3672).
Genentech does not influence or advocate the use of any one specialty distributor or specialty pharmacy. We make no representation or guarantee of service or coverage of any item. For any product-specific distribution questions, call ACTEMRA Access Solutions at 1-800-ACTEMRA (1-800-228-3672) (6AM-5PM PST, Monday through Friday).
We are serious about patient safety. If your Genentech product is spoiled, expired or damaged, we may be able to help you replace it.
Please contact Genentech Customer Service at 800-551-2231 for any order or return-related questions.
We are open from 6AM-5PM PST, Mon. through Fri., except for the following holidays:
ACTEMRA [package insert]. South San Francisco, CA: Genentech, Inc.
ACTEMRA [package insert]. South San Francisco, CA: Genentech, Inc.
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Data on file, GiACTA CSR. Genentech, Inc. South San Francisco, CA.
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Data on file, Actemra IV GCA CSR. Genentech, Inc, South San Francisco, CA.
Data on file, Actemra IV GCA CSR. Genentech, Inc, South San Francisco, CA.
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