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xeloda patient assistance forms

by Alene Purdy Published 2 years ago Updated 1 year ago
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How do I apply for the Xeloda Patient Assistance Program?

Applying for the Xeloda patient assistance program through NiceRx is simple. Begin by completing the enrollment application on our website. We will ask for details about your healthcare provider, your insurance plan, and your household income. This information is required by the pharmaceutical manufacturers that supply your medication.

Does health insurance cover Xeloda for cancer?

Many cancer patients quickly find out that health insurance does not cover 100% of the costs for cancer treatments or for cancer drugs like Xeloda. Health insurance co-pays, high deductibles and annual prescription caps often force cancer patients and their families to seek alternative funding options.

What is the Xeloda settlement program?

The settlement is often used to subsidize cancer treatments, out of pocket costs for drugs like Xeloda or any other personal expenses. In order to be eligible for our program, the patient must be the insured person with a minimum life insurance benefit of $100,000.

What are the contraindications for Xeloda?

Xeloda is contraindicated in patients with severe renal impairment (creatinine clearance below 30 mL/muin [Cockroft and Gault]). Xeloda is contraindicated in patients with known hypersensitivity to capecitabine or to any of its components or to 5-fluorouracil.

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How much does Xeloda pills cost?

The retail price of Xeloda is $4,745.37. With SingleCare, Xeloda costs $63.65 for 84, 500mg Tablet of generic Xeloda. It pays to ask your pharmacist to compare your Xeloda insurance copay to your SingleCare Xeloda coupon. The SingleCare savings may be considerably greater.

What is the Genentech Patient Foundation?

The Genentech Patient Foundation gives free Genentech medicine to people who don't have insurance coverage or who have financial concerns.

Who manufactures Xeloda?

Genentech: Xeloda® (capecitabine) - Information for Patients.

What drugs does Genentech make?

Our Medicines & ProductsMedicines.Actemra® (TOCILIZUMAB [authorized for Emergency Use])Actemra® (tocilizumab)Activase® (alteplase)Alecensa® (alectinib)Avastin® (bevacizumab)Boniva Tablets® (ibandronate sodium)Cathflo Activase® (alteplase)More items...

How long do you stay on Xeloda?

Xeloda is meant to be used as a long-term treatment. For metastatic breast or colorectal cancer, you'll usually take Xeloda for as long as it continues to be safe and effective for you. For adjuvant treatment of colon cancer, you'll usually take Xeloda for 6 months (eight 3-week cycles).

What is the success rate of Xeloda?

In a phase II trial of 163 paclitaxel-refractory patients with metastatic breast cancer, the overall response rate with Xeloda was 20%, with three complete responses, and the median survival was 12.8 months. A total of 20% of patients experienced a Clinical Benefit Response (a composite assessment of clinical benefit).

What is the success rate of capecitabine?

3). In particular, the 5-year EFS is 100% in patients with capecitabine duration ≥30 months compared to 43% in patients with capecitabine duration <30 months. In addition, the Kaplan-Meier estimate of the 5-year overall survival rate was 78% (95% CI: 63–96%).

What is Genentech famous?

Genentech is a biotechnology company dedicated to pursuing groundbreaking science to discover and develop medicines for people with serious and life-threatening diseases. Our transformational discoveries include the first targeted antibody for cancer and the first medicine for primary progressive multiple sclerosis.

Who acquired Genentech?

Roche Holding'sRoche Holding's agreement on Thursday to acquire full ownership of Genentech for $46.8 billion is the third big drug industry merger this year.

Where is Genentech headquarters?

South San Francisco, CAGenentech / HeadquartersGenentech's corporate headquarters are in South San Francisco, California (37.657°N 122.379°W), with additional manufacturing facilities in Vacaville, California; Oceanside, California; and Hillsboro, Oregon.

Who started Genentech?

Robert A. SwansonHerbert BoyerGenentech/Founders

Prescriber Service Form

The Prescriber Service Form includes patient, insurance and prescription information and is used when Genentech Access Solutions contacts a patient’s health insurance plan to determine his or her coverage.

Patient Consent Form

This form is signed and dated by your patient giving written permission for Genentech Access Solutions to discuss his or her health information with you and the patient’s health insurance plan.

Formulario de Consentimiento del Paciente

A version of the Patient Consent Form for your Spanish-speaking patients.

Combined Prescriber Service Form and Patient Consent Form

Download or print the Prescriber Service Form and the Patient Consent Form together in a single packet.

Other Important Documents

The Genentech Patient Foundation gives free Genentech medicine to people who don't have insurance or who have financial concerns and meet eligibility criteria. Two forms are needed to enroll in the Genentech Patient Foundation:

How to report Xeloda side effects?

Report side effects for your Xeloda prescription. Report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555. Get help paying for your Xeloda prescription. Genentech Patient Resource Center.

What is Xeloda used for?

Xeloda is a prescription medicine used to treat people with: cancer of the colon that has spread to lymph nodes in the area close to the colon (Dukes’ C stage), after they have surgery. cancer of the colon or rectum (colorectal) that has spread to other parts of the body (metastatic). breast cancer that has spread to other parts ...

How to contact Genentech about Xeloda?

Ask about possible side effects and any other medical questions related to your prescribed Genentech medicine. Call us at (800) 821-8590, Monday-Friday, 5am-5pm PT. Chat with us using our live chat feature, Monday-Friday, 5am-5pm PT.

How to report side effects of Genentech?

If you have any questions about your condition or treatment, talk to your doctor. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555. Please see full Product Information for additional important safety information.

Does Xeloda cause heart problems?

heart problems. XELODA can cause heart problems including: heart attack and decreased blood flow to the heart, chest pain, irregular heartbeats, changes in the electrical activity of your heart seen on an electrocardiogram (ECG), problems with your heart muscle, heart failure, and sudden death.

Can you breastfeed with Xeloda?

are breastfeeding or plan to breastfeed. It is not known if Xeloda passes into breast milk. Do not breastfeed during treatment with Xeloda. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Can Xeloda cause blood clots?

Taking XELODA with these medicines can cause changes in how fast your blood clots, and can cause bleeding that can lead to death.

What is a client care advocate?

A Client Care Advocate is available to help you understand your options and determine if our life insurance settlement program can relieve financial pressures caused by the high costs of cancer treatments.

How to contact Quick Life Settlement?

Complete our Quick Life Settlement Qualifier or call us toll-free at 1.877.227.4484 to speak with a Client Care Advocate.

What is Xeloda used for?from gene.com

Xeloda (capecitabine) is a member of the antimetabolites drug class and is commonly used for Breast Cancer, Breast Cancer - Metastatic, and Colorectal Cancer.

What is a client care advocate?from welcomefunds.com

A Client Care Advocate is available to help you understand your options and determine if our life insurance settlement program can relieve financial pressures caused by the high costs of cancer treatments.

What is Genentech Access to Care Foundation?from drugs.com

The Genentech Access to Care Foundation is now the Genentech Patient Foundation. Eligibility determined on a case-by-case basis. Call for most recent medications as the list is subject to change.

How to report side effects of Genentech?from gene.com

If you have any questions about your condition or treatment, talk to your doctor. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555. Please see full Product Information for additional important safety information.

How much does a free drug card save?from drugs.com

The free Drugs.com Discount Card works like a coupon and can save you up to 80% or more off the cost of prescription medicines, over-the-counter drugs and pet prescriptions.

Can you breastfeed with Xeloda?from gene.com

are breastfeeding or plan to breastfeed. It is not known if Xeloda passes into breast milk. Do not breastfeed during treatment with Xeloda. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

How to contact Quick Life Settlement?from welcomefunds.com

Complete our Quick Life Settlement Qualifier or call us toll-free at 1.877.227.4484 to speak with a Client Care Advocate.

What is Xeloda used for?

Xeloda (capecitabine) is a member of the antimetabolites drug class and is commonly used for Breast Cancer, Breast Cancer - Metastatic, and Colorectal Cancer.

How much does a free drug card save?

The free Drugs.com Discount Card works like a coupon and can save you up to 80% or more off the cost of prescription medicines, over-the-counter drugs and pet prescriptions.

What is Genentech Access to Care Foundation?

The Genentech Access to Care Foundation is now the Genentech Patient Foundation. Eligibility determined on a case-by-case basis. Call for most recent medications as the list is subject to change.

What is Xeloda used for?

Xeloda in combination with docetaxel is indicated for the treatment of patients with metastatic breast cancer after failure of prior anthracycline-containing chemotherapy.

How to contact Genentech about Xeloda?

Get answers to your questions about prescribing Xeloda. Medicine Information Support. Medical information about Genentech medicines. Call us at (800) 821-8590, Monday-Friday, 5am-5pm PT. Request a Call Back. Request an Office Visit with a Medical Science Liaison. Online Chat.

How long after Xeloda can you breastfeed?

Advise females not to breastfeed during treatment with Xeloda and for 2 weeks after the last dose.

What are the most common adverse reactions to Xeloda?

The most common adverse reactions (≥30%) with Xeloda were diarrhea, hand-and-foot syndrome, nausea, vomiting, abdominal pain, fatigue/weakness, and hyperbilirubinemia. Other adverse reactions, including serious adverse reactions, have been reported.

When to interrupt Xeloda?

Interrupt Xeloda treatment until the hand-and-foot syndrome event resolves or decreases in intensity. Hyperbilirubinemia: Interrupt Xeloda treatment immediately until the hyperbilirubinemia resolves or decreases in intensity.

Can Xeloda be discontinued?

Xeloda should be permanently discontinued in patients who experience a severe mucocutaneous reaction during treatment. Xeloda may induce hand-and-foot syndrome. Persistent or severe hand-and-foot syndrome can lead to loss of fingerprints which could impact patient identification.

Is Xeloda safe for DPD?

Increased risk of severe or fatal adverse reactions in patients with low or absent Dihydropyrimidine Dehydrogenase Deficiency (DPD) activity: Withhold or permanently discontinue Xeloda in patients with evidence of acute early-onset or unusually severe toxicity, which may indicate near complete or total absence of DPD activity. No Xeloda dose has been proven safe in patients with absent DPD activity.

What is Xeloda used for?from gene.com

Xeloda (capecitabine) is a member of the antimetabolites drug class and is commonly used for Breast Cancer, Breast Cancer - Metastatic, and Colorectal Cancer.

What is a client care advocate?from welcomefunds.com

A Client Care Advocate is available to help you understand your options and determine if our life insurance settlement program can relieve financial pressures caused by the high costs of cancer treatments.

What is Genentech Access to Care Foundation?from drugs.com

The Genentech Access to Care Foundation is now the Genentech Patient Foundation. Eligibility determined on a case-by-case basis. Call for most recent medications as the list is subject to change.

How much does capecitabine cost?from drugs.com

Capecitabine Prices. The cost for capecitabine oral tablet 500 mg is around $111 for a supply of 120 tablets, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.

How to report side effects of Genentech?from gene.com

If you have any questions about your condition or treatment, talk to your doctor. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555. Please see full Product Information for additional important safety information.

How much does a free drug card save?from drugs.com

The free Drugs.com Discount Card works like a coupon and can save you up to 80% or more off the cost of prescription medicines, over-the-counter drugs and pet prescriptions.

Can you breastfeed with Xeloda?from gene.com

are breastfeeding or plan to breastfeed. It is not known if Xeloda passes into breast milk. Do not breastfeed during treatment with Xeloda. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

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