Genentech is committed to helping you access the medicine you have been prescribed

Activation

Begin the activation process for your Valcyte®
Co-pay Card by answering the questions below to determine if you are eligible for the program.

If you are activating the card on behalf of a patient, please answer the questions from his or her perspective.

Valcyte® Co-pay Card
Terms and Conditions

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  1. Are you a resident of the United States or Puerto Rico?
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  2. Are you a resident of Massachusetts?
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  3. Are you a government beneficiary and/or a participant in any state- or federally funded healthcare program, including but not limited to all Medicare, Medicaid, Medigap, VA, DoD, or TRICARE?
    • Please complete
  4. Are you receiving free drug or assistance through the Genentech® Access to Care Foundation or any other charitable organization?
    • Please complete
  5. Do you take Valcyte® (valganciclovir hydrochloride) for any of the indications listed below?
    • For the treatment of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS)
    • To help prevent CMV disease in adult heart, kidney, or kidney-pancreas transplant patients with a high chance of developing CMV disease
    • To help prevent CMV disease in pediatric heart or kidney transplant patients with a high chance of developing CMV disease
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  6. The patient information disclosed during this enrollment, including name, email address, mailing address, and phone number, will be shared with Genentech, the sponsor of the card. In addition, information shared by the patient’s pharmacy/physician, such as the date the patient filled the prescription, the date the medication was administered by patient’s physician (if applicable), and the amount that patient will be reimbursed by Genentech, will be shared with Genentech, the sponsor of this card. The patient agrees to be contacted by phone, mail, or email with the information and/or materials about the patient’s Genentech Valcyte® Co-pay Card. For more information, please see the Genentech Privacy Policy at www.gene.com.
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  7. I certify that I have patient's consent to proceed with the enrollment of the Genentech Valcyte® Co-pay Card and I am 18 years of age or older.
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  8. If you begin receiving prescription benefits from such a federal-, state-, or other government-funded program at any time, you will no longer be eligible to participate in this program. We may contact you by phone or mail periodically in order to verify that your eligibility for the program has not changed.

    Do you acknowledge your agreement with this statement?

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  9. How did you hear about the Valcyte® Co-pay Card?
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Activation

Complete the activation process by providing your personal information below.

Enrollment

Complete the enrollment process by providing your personal information below.

In order to receive benefits at the pharmacy, it is important that you provide accurate information. Your personal information is required for security purposes and is used only to administer this program. Genentech understands that your privacy is important and that you have the right to have your personal, medical, and financial information kept confidential. Please note that by providing your name, address, or other information, you are giving Genentech and companies working with Genentech permission to communicate with you about this program. We will not send, sell, or transfer your name, address, or other personally identifiable information about you that we secure through this program to any party for marketing of goods or services unrelated to this program.

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Patient already enrolled

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If you have received your Valcyte® Co-pay Card, please enter the 9-digit number on the front of the card. To locate the card ID, click on the to see an image of the card.

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Valcyte Co-pay Card Image

Congratulations!

You have successfully enrolled in the
Valcyte® Co-pay Card program

Start saving today with a temporary card

You will receive your activated Valcyte® Co-pay Card
in 7 to 10 business days. That doesn't mean you
have to wait to start saving, you can click below to
print your temporary Valcyte® Co-pay Card.

Print your temporary Valcyte® Co-pay Card

How to use your card

Present your card along with your prescription to your
pharmacist to help reduce your out-of-pocket costs.

Valcyte Co-pay Card Image

Congratulations!

You have successfully activated your
Valcyte® Co-pay Card

How to use your card

Present your card along with your prescription to your pharmacist to help reduce your out-of-pocket costs.

We're sorry, but you are not eligible for this program

  • We appreciate your interest; however, you are not eligible to participate in the Valcyte® Co-pay
    Card program. Other programs through Genentech® Transplant Access Services (GTAS) may be able to help
  • If you have insurance and have difficulty paying your co-pay, co-insurance, or other expenses, Genentech can refer you to a co-pay assistance foundation* that provides co-pay assistance and support for your specific disease state
  • The Genentech® Access to Care Foundation (GATCF) can help you receive Valcyte free of charge, if you qualify. GATCF helps people who have health insurance and those who don't. If you qualify for GATCF, you could receive Valcyte free of charge

Talk to your transplant team about the programs and services offered by Genentech® Transplant Access Services.

You can also visit www.TransplantAccessServices.com to learn more, or call 888-754-7651 (9:00 AM to 7:00 PM ET Mon-Fri) to talk to a member of the Genentech® Transplant Access Services team.