Activase Patient Assistance Programs

Activase: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Activase. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not or go to the program website.

Looking for a different medication?

Genentech Patient Foundation

(Program 1 of 1 — Scroll down to see them all )

Provided by: Genentech USA, Inc.
TEL: 888-941-3331
FAX: 833-999-4363
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
  • Activase (alteplase)
Eligibility Requirements
  • Insurance Status Uninsured or Underinsured with no prescription coverage for needed medication
  • Those with Part D Elibible? Contact program for details.
  • Income Income Guidelines published on Program Website
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be treated by US licensed healthcare provider
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section and sign
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Varies
  • Amount/Supply Amount requested is sent
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Varies
  • Refill Proces Varies per medication
  • Limit Not specified
  • Re-application Not specified
Additional Information
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.
Updated April 16, 2019

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