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

Join the Valcyte® $15 Co-pay Card program

Answer the questions below to join the Valcyte® $15
Co-pay Card program and you could start saving today.

If you are enrolling in the program on behalf of a patient, please answer the questions from his or her perspective.

Valcyte® $15 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?
    • 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® $15 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® $15 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® $15 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.

By providing your information you agree to allow Genentech and its agents to collect the information provided and to be contacted by Genentech and its agents using this information in the future. Furthermore, you are agreeing that Genentech and its agents may contact you by phone, e-mail, or mail, and that such electronic or other written communications may include information regarding your health within them. Genentech will not sell, rent, or otherwise distribute your name and any personally identifiable information outside of Genentech and its agents. Genentech will only use your information in accordance with the Genentech Privacy Policy.

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Patient already enrolled

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If you have received your Valcyte® $15 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 signed up for
the Valcyte® $15 Co-pay Card program

Start using your temporary card today

You will receive your activated Valcyte® $15 Co-pay Card
in 7 to 10 business days. Click below to print your
temporary Valcyte® $15 Co-pay Card.

Print your temporary Valcyte® $15 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® $15 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

Even if you don't qualify for the Valcyte® $15 Co-pay Card program, Genentech Transplant Access Services (GTAS) may be able to help you get the medicine you need.

To find out more about patient assistance options, call 1-888-754-7651 (9:00 am to 7:00 pm ET Mon-Fri).