Patient Assistance options
You may be eligible to receive free GENGRAF if you:
- Have been prescribed GENGRAF
- Have limited or no health insurance coverage
- Live in the United States
- Are being treated by a licensed U.S. health care provider on an outpatient basis
- Demonstrate qualifying financial need based on a combination of your insurance coverage, household income, and out-of-pocket medical expenses during the application process. But to help you understand whether you meet the income guidelines, we’ve provided the table below:
| Household size | Annual income |
| 1 | $81,540 or less |
| 2 | $109,860 or less |
| 3 | $138,180 or less |
| 4 | $166,500 or less |
| After 4, add $28,320 for each additional dependent family member |
If you meet the requirements above, you should work with your healthcare provider to submit a program application. To avoid delays, please follow the instructions on the first page and submit all requested information. Please download the application below.
GENGRAF application (Spanish)
Medicare patients may qualify for Extra Help from Medicare.