The GATCF program can help connect underinsured patients with financial assistance foundations. To qualify for support, patients must meet specific criteria.

To apply, please download and fax the below forms to 1-800-305-1830:

 

  • Patient Notice of Request for Transmission of Health Information (PAN) form in English filled out by the patient.
  • Statement of Medical Necessity (SMN) with appropriate services indicated filled your by your healthcare provider. Download English.

 

Please call 877 4 FUZEON if you have any additional questions.