Helpful Resources for Your Practice

Pulmozyme Access Solutions offers a range of access and reimbursement resources for your patients and practice after Pulmozyme is prescribed, including help with benefits investigations (BI), resources for prior authorizations (PA), sample billing and coding information, resources for denials and appeals, information about specialty pharmacies (SP) and referrals to potential financial assistance options.

Coverage

Get help understanding insurance benefits and coverage, such as with benefits investigations and prior authorization resources

Benefits investigations
Pulmozyme Access Solutions can conduct a benefits investigation (BI) to help you determine if a prescribed Genentech medicine is covered, if prior authorizations are required, which specialty pharmacy  the health insurance plan prefers and if patient assistance might be needed.

Potential outcomes of a BI:

  • Treatment is covered
  • Prior authorization is required*
  • Treatment is denied

*If your patient’s request for a prior authorization is not granted, your Pulmozyme Access Solutions Specialist can work with you to determine your next steps.

Option 1: Submit forms online

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?

  • An online tool to help you enroll patients in Pulmozyme Access Solutions and manage your service requests at your convenience.

Option 2: Print forms and fax or text

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 completed forms via fax or text.

Both forms are required. No action can be taken until a completed Patient Consent Form and Prescriber Service Form have been received. 

What to expect next:

  • The request will be processed within 5 business days upon receipt of both required forms
  • Your office will be contacted to discuss the application outcome and any next steps

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.


Reimbursement

Sample coding information and resources for denials and appeals

Pulmozyme Sample Coding

This coding information may assist you as you complete the payer forms for Pulmozyme. 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.

Appeals

If your patient’s health insurance plan has issued a denial, your Pulmozyme 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: 

  1. The denial should be reviewed, along with the health insurance plan’s guidelines to determine what to include in your patient’s appeal submission.
  2. Your Pulmozyme Access Solutions Specialist has local payer coverage expertise and can help you determine specific requirements for your patient.

A sample appeal letter and additional considerations are available on the Practice Forms and Documents page.

Appeals cannot be completed or submitted by Pulmozyme Access Solutions on your behalf.


Online patient enrollment

Submit Pulmozyme Access Solutions forms and check the status of your service requests online using My Patient Solutions.

My Patient Solutions is an online tool to help you enroll patients in Pulmozyme Access Solutions and manage your service requests, all through one portal. It allows you the flexibility to work with Pulmozyme Access Solutions when it’s convenient for you.

With My Patient Solutions, you can:

  • Enroll and re-enroll patients in financial assistance programs entirely online

  • Communicate with your Pulmozyme Access Solutions Specialist

  • Easily identify next steps for service requests
  • 
View Benefits Investigation reports for all your enrolled patients
  • 
Follow up on prior authorizations or appeals
  • View Pulmozyme Co-pay Assistance Program outcomes

How to register

Account registration can be completed by 1 person for the entire practice and for multiple practice locations. For help with registration or if you have questions, call Pulmozyme Access Solutions at 866-422-2377 (6AM-5PM PT, Monday through Friday).


Pulmozyme distributors

Pulmozyme Access Solutions works with SPs to help patients receive their prescribed Genentech medicines.

SPs may provide the following services:

  • Clinical services to support patients throughout their treatment
  • The ability to manage the specialty handling and shipping needs linked with many specialty therapies

You can work with your preferred SP or contact Pulmozyme Access Solutions to learn which SP the patient’s health insurance plan requires.

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.

Contact a representative

Questions about these resources?

A Pulmozyme Access Solutions Specialist is ready to help. Call 800-690-3023 (Mon.-Fri., 6AM-5PM PST, except major holidays)

Financial support

Financial Support

Find the right financial resources option for your patients.

  • We are open from 6AM-5PM PST, Mon. through Fri., except for the following holidays:

    • New Year's Day
    • Memorial Day
    • Independence Day
    • Labor Day
    • Thanksgiving Holiday (Thursday and Friday)
    • Christmas Day

Indication and Usage

Pulmozyme (dornase alfa) is indicated for daily administration in conjunction with standard therapies for the management of cystic fibrosis (CF) patients to improve pulmonary function.

In CF patients with an FVC ≥ 40% of predicted, daily administration of Pulmozyme has also been shown to reduce the risk of respiratory tract infections requiring parenteral antibiotics.

Important Safety Information

Pulmozyme is contraindicated in patients with known hypersensitivity to dornase alfa, Chinese Hamster Ovary cell products, or any component of the product.

The most common adverse reactions associated with the use of Pulmozyme include: voice alteration, pharyngitis, rash, laryngitis, chest pain, conjunctivitis, rhinitis, decrease in FVC of ≥ 10%, fever, dyspepsia, and dyspnea. There have been no reports of anaphylaxis attributed to the administration of Pulmozyme. Mild to moderate urticaria and mild skin rash have been observed and have been transient.

Pediatric Use

The safety and effectiveness of Pulmozyme have been established in pediatric patients 5 years of age and older. The safety of Pulmozyme, 2.5 mg by inhalation, was studied with 2 weeks of daily administration in 65 patients with cystic fibrosis aged 3 months to < 5 years. While clinical trial data are limited in pediatric patients younger than 5 years of age, the use of Pulmozyme should be considered for pediatric CF patients who may experience potential benefit in pulmonary function or who may be at risk of respiratory tract infection.

The safety of Pulmozyme, 2.5 mg by inhalation, was studied with 2 weeks of daily administration in 98 pediatric patients with cystic fibrosis 3 months to 10 years of age (65 aged 3 months to < 5 years, 33 aged 5 to ≤ 10 years). The PARI BABY™ reusable nebulizer (which uses a facemask instead of a mouthpiece) was utilized in patients unable to demonstrate the ability to inhale or exhale orally throughout the entire treatment period (54/65, 83% of the younger; and 2/33, 6% of the older patients). Overall, the nature of adverse reactions was similar to that seen in the placebo-controlled trials in older patients. The number of patients reporting cough was higher in the younger age group as compared to the older age group (29/65, 45%; compared to 10/33, 30%) as was the number reporting moderate to severe cough (24/65, 37%; compared to 6/33, 18%). The number of patients reporting rhinitis was higher in the younger age group as compared to the older age group (23/65, 35%; compared to 9/33, 27%) as was the number reporting rash (4/65, 6% as compared to 0/33, 0%).

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 Pulmozyme Prescribing Information for additional Important Safety Information.

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    Non-US Residents visit: Pulmozyme.global