Reimbursement

To initiate treatment with RAPTIVA, Genentech has developed a comprehensive and innovative reimbursement support resource for your patients, which brings together the knowledge we have gained after 18 years of working with Specialty Pharmacies. RAPTIVA Access Solutions^TM, in conjunction with a network of Specialty Pharmacies, provides one convenient source for access to treatment with RAPTIVA. Together, RAPTIVA Access Solutions and the Specialty Pharmacies navigate the reimbursement and distribution process-as the healthcare provider, all you have to do is send one simple fax.

The RAPTIVA Access Solutions Process

As the healthcare provider, you will complete the Statement of Medical Necessity (SMN) and Patient Authorization Notification (PAN) forms and fax them accordingly to RAPTIVA Access Solutions. RAPTIVA Access Solutions will then recommend a Specialty Pharmacy that best meets your needs and the requirements of your patient's health plan

• The SMN serves as the prescription, provides authorization for at-home injection training, and triggers the reimbursement process
• The Specialty Pharmacy works to investigate your patient's insurance benefits, obtains authorization, and conducts insurance appeals
• The Specialty Pharmacy also ships RAPTIVA directly to your patient or your office after approvals are obtained, supports patient compliance, and provides supplemental injection training if needed
• If a patient's health plan does not cover one of the Specialty Pharmacies within the RAPTIVA Access Solutions network, RAPTIVA Access Solutions will obtain insurance authorization and then direct the case to an in-network pharmacy that can handle distribution as necessary

Initiating treatment with RAPTIVA is a simple, streamlined process designed to serve both you as the healthcare provider and your patients as efficiently as possible.

What can I expect after submitting the forms to RAPTIVA Access Solutions?

The Specialty Pharmacy will keep you informed about the approval of your patient's application. Your office will receive an acknowledgement fax letting you know who is handling the authorization (RAPTIVA Access Solutions or the Specialty Pharmacy) within 2 business days after a patient's forms are received. Your patient should generally receive an update from either RAPTIVA Access Solutions or the Specialty Pharmacy within 3 business days. The time required to review an authorization for medication varies among insurance plans.

How can I contact RAPTIVA Access Solutions?

Phone number: 1-866-480-7762
Hours of operation: Monday - Friday, 6:00 AM - 5:00 PM PST
Web address: www.RAPTIVAAccessSolutions.com

Mailing address:

RAPTIVA Access Solutions
1 DNA Way, Mail Stop 210
South San Francisco, CA 94080

For more information about RAPTIVA Access Solutions, visit www.RAPTIVAAccessSolutions.com