KADCYLA Access Solutions offers a range of access and reimbursement resources for your patients and practice after KADCYLA is prescribed, including help with benefits investigations (BIs), resources for prior authorizations (PAs), sample billing and coding information, resources for denials and appeals, information about distribution and referrals to potential financial assistance options.
Get help understanding insurance benefits and coverage, such as with benefits investigations and prior authorization resources.
KADCYLA Access Solutions can conduct a benefits investigation (BI) which can determine:
*If your patient’s request for a prior authorization is not granted, your KADCYLA Access Solutions Specialist can work with you to determine your next steps.
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?
Your patient is required to complete the Patient Consent Form. You can either upload their Patient Consent Form as part of your application or have your patient submit the form via fax, text or e-submit.
An online tool to help you enroll patients in KADCYLA Access Solutions and manage your service requests at your convenience.
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 the completed forms via fax or text.
Both forms are required. We must have both the Patient Consent Form and the Prescriber Service Form before we can help you.
Genentech reserves the right to modify or discontinue the program at any time and to verify the accuracy of information submitted.
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and healthcare provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.
Sample coding information and resources for denials and appeals
This coding information may assist you as you complete the payer forms for KADCYLA. 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.
Download sample coding and the Important Safety Information for KADCYLA below.
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.
If your patient’s health insurance plan has issued a denial, your KADCYLA 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:
A sample appeal letter and additional considerations are available on the Practice Forms and Documents page.
Appeals cannot be completed or submitted by Genentech on your behalf.
Submit KADCYLA 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 KADCYLA Access Solutions and manage your service requests, all through one portal. It allows you the flexibility to work with KADCYLA Access Solutions when it’s convenient for you.
With My Patient Solutions, you can:
How to register
Account registration can be completed by one person for the entire practice and for multiple practice locations. For help with registration or if you have questions, call us at 877-GENENTECH (877-436-3683) (6AM-5PM PST, Monday through Friday).
Genentech has contracted with a network of authorized specialty distributors and specialty pharmacies (SPs) to service practices choosing to prescribe KADCYLA.
These partners have made a commitment to product integrity and have agreed to distribute only products purchased directly from Genentech and not to distribute KADCYLA through secondary channels.
For a full list of authorized distributors and in-network specialty pharmacies, please visit the Genentech Access Solutions website or contact KADCYLA Access Solutions at 888-249-4918.
With Buy and Bill, the practice purchases the medication in advance, then bills the patient's health insurance plan for reimbursement. The practice is responsible for storing and handling the drug as well as collecting the patient's co-pay for both the drug and its administration. With Buy and Bill, practices can maintain a stock of the drug, giving them the flexibility to treat patients when clinically appropriate.
KADCYLA Access Solutions works with specialty pharmacies (SPs) to help patients receive their prescribed Genentech medicines.
In addition to distributing medicines, an SP may provide the following services:
You can work with your preferred SP or contact KADCYLA Access Solutions to learn which SP the patient’s health insurance plan mandates or prefers.
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. For any product-specific distribution questions, call KADCYLA Access Solutions at 888-249-4918 (6AM-5PM PST, Monday through Friday).
We are serious about patient safety. If your Genentech product is spoiled, expired or damaged, we may be able to help you replace it.
Please contact Genentech Customer Service at (800) 551-2231 for any order or return-related questions.
Gianni L, et al. Lancet Oncol. 2016;17(6):791-800.
Gianni L, et al. Lancet Oncol. 2016;17(6):791-800.
Data on file. Genentech, Inc.
Data on file. Genentech, Inc.
Cortazar P, et al. Lancet. 2014;384(9938):164-172.
Cortazar P, et al. Lancet. 2014;384(9938):164-172.
KADCYLA Prescribing Information. Genentech, Inc. 2022.
KADCYLA Prescribing Information. Genentech, Inc. 2022.
Roche.com. FDA approves Roche's Kadcyla (trastuzumab emtansine), the first antibody-drug conjugate for treating HER2-positive metastatic breast cancer.
Roche.com. FDA approves Roche's Kadcyla (trastuzumab emtansine), the first antibody-drug conjugate for treating HER2-positive metastatic breast cancer.
Verma S, Miles D, Gianni L, et al; EMILIA Study Group. Trastuzumab emtansine for HER2-positive advanced breast cancer [published correction appears in N Engl J Med. 2013;368:2442]. N Engl J Med. 2012;367:1783-1791 and Supplementary Appendix.
Verma S, Miles D, Gianni L, et al; EMILIA Study Group. Trastuzumab emtansine for HER2-positive advanced breast cancer [published correction appears in N Engl J Med. 2013;368:2442]. N Engl J Med. 2012;367:1783-1791 and Supplementary Appendix.
Junttila TT, Li G, Parsons K, Phillips GL, Sliwkowski MX. Trastuzumab-DM1 (T-DM1) retains all the mechanisms of action of trastuzumab and efficiently inhibits growth of lapatinib insensitive breast cancer. Breast Cancer Res Treat. 2011;128:347-356.
Junttila TT, Li G, Parsons K, Phillips GL, Sliwkowski MX. Trastuzumab-DM1 (T-DM1) retains all the mechanisms of action of trastuzumab and efficiently inhibits growth of lapatinib insensitive breast cancer. Breast Cancer Res Treat. 2011;128:347-356.
Staudecher AH, Brown MP. Antibody drug conjugates and bystander killing: is antigen-dependent internalisation required? Br J Cancer. 2017;117(12):1736-1742.
Staudecher AH, Brown MP. Antibody drug conjugates and bystander killing: is antigen-dependent internalisation required? Br J Cancer. 2017;117(12):1736-1742.
Lewis Phillips GD, Li G, Dugger DL, et al. Targeting HER2-positive breast cancer with trastuzumab-DM1, an antibody-cytotoxic drug conjugate. Cancer Res. 2008;68(22):9280-9290.
Lewis Phillips GD, Li G, Dugger DL, et al. Targeting HER2-positive breast cancer with trastuzumab-DM1, an antibody-cytotoxic drug conjugate. Cancer Res. 2008;68(22):9280-9290.
Nahta R, Esteva FJ. Herceptin: mechanisms of action and resistance. Cancer Lett. 2006; 232:123-138.
Nahta R, Esteva FJ. Herceptin: mechanisms of action and resistance. Cancer Lett. 2006; 232:123-138.
von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med. 2019;380(7):617-628.
von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med. 2019;380(7):617-628.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer V2.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed March 28, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer V2.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed March 28, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
Denduluri N, Somerfield MR, Chavez-MacGregor M, et al. Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Guideline Update. J Clin Oncol. 2021;39(6):685-693.
Denduluri N, Somerfield MR, Chavez-MacGregor M, et al. Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Guideline Update. J Clin Oncol. 2021;39(6):685-693.
Loibl S, Mano MS, Untch M, et al. Phase III study of adjuvant ado-trastuzumab emtansine vs trastuzumab for residual invasive HER2-positive early breast cancer after neoadjuvant chemotherapy and HER2-targeted therapy: KATHERINE final IDFS and updated OS analysis. Presented at: San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX. Accessed January 29, 2024.
Loibl S, Mano MS, Untch M, et al. Phase III study of adjuvant ado-trastuzumab emtansine vs trastuzumab for residual invasive HER2-positive early breast cancer after neoadjuvant chemotherapy and HER2-targeted therapy: KATHERINE final IDFS and updated OS analysis. Presented at: San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX. Accessed January 29, 2024.
Geyer CE, et al. Phase III study of trastuzumab emtansine (T-DM1) vs trastuzumab as adjuvant therapy in patients with HER2-positive early breast cancer with residual invasive disease after neoadjuvant chemotherapy and HER2-targeted therapy including trastuzumab: primary results from KATHERINE (NSABP B-50-I, GBG 77 and Roche BO27938). Presented at: San Antonio Breast Cancer Symposium; December 4-8, 2018.
Geyer CE, et al. Phase III study of trastuzumab emtansine (T-DM1) vs trastuzumab as adjuvant therapy in patients with HER2-positive early breast cancer with residual invasive disease after neoadjuvant chemotherapy and HER2-targeted therapy including trastuzumab: primary results from KATHERINE (NSABP B-50-I, GBG 77 and Roche BO27938). Presented at: San Antonio Breast Cancer Symposium; December 4-8, 2018.
This image shows the components of KADCYLA:
Trastuzumab–monoclonal antibody4
MCC–stable linker4,6
DM1–cytotoxic agent4,7
Overview
This image shows the trial design of KATHERINE.
Data
KATHERINE was a randomized, multicenter, open-label trial of 1,486 patients with HER2+ early breast cancer. Patients were required to have had residual invasive disease in the breast and/or axillary lymph nodes following neoadjuvant treatment with taxane + trastuzumab-based therapy. Patients were randomized to 3.6 mg/kg of KADCYLA or 6 mg/kg of Herceptin® (trastuzumab), with 743 patients in each arm.
Overview
This image shows a Kaplan-Meier curve of invasive disease-free survival (iDFS) in KATHERINE.
Data
Invasive disease-free survival, the primary end point, was significantly higher among patients who received KADCYLA than among those who received trastuzumab (hazard ratio, 0.54, 95% confidence interval [CI], 0.44-0.66; P<0.0001). 7-year iDFS was 80.8% in the KADCYLA group, compared to 67.1% in the trastuzumab group, representing a 46% reduction in the risk of recurrence
Overview
This image shows where KADCYLA fits in the HER2+ early breast cancer treatment plan and how many cycles of it to give.
Details
Following 3-6 cycles of neoadjuvant taxane + trastuzumab-based treatment, and surgery, give KADCYLA for 14 cycles, or until disease recurrence or unmanageable toxicity occurs.
Overview
This image shows the infusion schedule for KADCYLA in early breast cancer.
Details
The initial infusion of KADCYLA in EBC takes 90 minutes plus an observation time of at least 90 minutes to monitor for infusion-related reactions. If prior infusions were well tolerated, subsequent infusions take 30 minutes plus an observation time of at least 30 minutes.
Treat for a total of 14 cycles (every 3 weeks) unless there is disease recurrence or unmanageable toxicity.
Overview
This image shows the dose reduction schedule for adverse reactions to KADCYLA.
Details
The starting dose for KADCYLA is 3.6 mg/kg. The first dose reduction for KADCYLA is 3 mg/kg. The second dose reduction for KADCYLA is 2.4 mg/kg. After that, discontinue KADCYLA.
Overview
This image shows a Kaplan-Meier curve of overall survival (OS) in KATHERINE.
Data
Overall survival, the second interim endpoint, was significantly higher among patients who received KADCYLA than among those who received trastuzumab (hazard ratio, 0.66 (95% CI: 0.51-0.87; P=0.0027). 7-year OS was 89.1% in the KADCYLA group, compared to 84.4% in the trastuzumab group, representing a 34% reduction in the risk of death.
This image shows subgroup analysis of invasive disease-free survival, presented as a forest plot.
This image shows the 3-year subgroup analysis of invasive disease-free survival, presented as a forest plot.
This image shows the 7-year subgroup analysis of invasive disease-free survival, presented as a forest plot.
This image shows the components of KADCYLA:
Trastuzumab-monoclonal antibody1
MCC-stable linker1,3
DM1 cytotoxic agent1,4
Overview
This image shows the trial design of EMILIA.
Details
EMILIA was a randomized, open-label, international trial involving 991 patients with HER2+, unresectable, locally advanced or metastatic breast cancer who previously received trastuzumab and a taxane (separately or in combination). Inclusion criteria included progression during or after the most recent treatment for locally advanced or metastatic disease or within 6 months after treatment for early-stage disease. Four hundred ninety-five patients were randomized to 21-day cycles of 3.6 mg/kg IV of KADCYLA on day 1. Four hundred ninety-six patients were randomized to 1,250 mg of lapatinib by mouth once daily, and 1,000 mg/m² of capecitabine by mouth twice daily on days 1-14. Treatment continued until disease progression or unacceptable toxicity.
Overview
This image shows the trial design of TH3RESA.
Details
TH3RESA was a phase 3, randomized, multicenter, open-label trial of 602 patients with HER2+ advanced breast cancer (ABC). Patients were required to have had disease progression after treatment with ≥2 prior HER2-directed therapies for ABC and prior treatment with trastuzumab, lapatinib, and a taxane. Patients were randomized to 3.6 mg/kg IV of KADCYLA or treatment of physician’s choice (TPC)* per local practice, with 404 patients in the KADCYLA arm and 198 patients in the TPC arm. Patients in the TPC arm who had disease progression had the option to cross over to the KADCYLA arm, and 93 patients did so.
Overview
This image shows overall survival (OS) results for EMILIA.
Data
KADCYLA significantly increased median OS (30.9 months, vs 25.1 months with lapatinib + capecitabine—a nearly 6-month improvement in median OS; hazard ratio for death from any cause, 0.68; 95% confidence interval, 0.55 to 0.85; P=0.0006).
Overview
This image shows progression-free survival (PFS) results for EMILIA.
Data
Treatment with KADCYLA significantly improved PFS as assessed by independent review (median survival, 9.6 months, vs 6.4 months with lapatinib + capecitabine—a 50% improvement in median PFS; stratified hazard ratio for progression or death from any cause, 0.65; 95% confidence interval, 0.55 to 0.77; P<0.0001).
Overview
This image shows objective response rate (ORR) results for EMILIA.
Data
Patients treated with KADCYLA had a higher ORR (43.6%, vs 30.8% with lapatinib + capecitabine—a 12.7% improvement in ORR; 95% confidence interval, 6.0-19.4%).
Overview
This image shows duration of response (DoR) results for EMILIA.
Data
Treatment with KADCYLA significantly improved DoR (median DoR, 12.6 months, vs 6.5 months with lapatinib + capecitabine—nearly doubling DoR; 95% confidence interval, 8.4-20.8).
Overview
This image shows overall survival (OS) in patients with central nervous system (CNS) metastases at baseline in EMILIA.
Data
The estimated median OS was 26.8 months with KADCYLA vs 12.9 months with lapatinib + capecitabine.
Overview
This image shows progression-free survival (PFS) by independent review committee (IRC) in patients with central nervous system (CNS) metastases at baseline in EMILIA.
Data
The estimated median PFS was 5.9 months with KADCYLA vs 5.7 months with lapatinib + capecitabine.
Overview
This image shows progression-free survival (PFS) by investigator results for TH3RESA.
Data
Median PFS with KADCYLA was 6.2 months, vs 3.3 months with treatment of physician’s choice (TPC). Stratified HR=0.528; 95% confidence interval, 0.422 to 0.661; P<0.0001.
Overview
This image shows overall survival (OS) results for TH3RESA in the ITT population.
Data
Median OS with KADCYLA was 22.7 months, vs 15.8 months with treatment of physician’s choice (TPC). Stratified HR=0.68; 95% confidence interval, 0.54 to 0.85; P=0.0007.
Overview
This image shows the most common severe (Grade ≥3) adverse reactions in EMILIA.
Data
Numerical values presented on the image:
Grade ≥3 nausea seen in 0.8% of KADCYLA patients, compared to 2.5% of lapatinib + capecitabine patients
Grade ≥3 fatigue seen in 2.5% of KADCYLA patients, compared to 3.5% of lapatinib + capecitabine patients
Grade ≥3 thrombocytopenia seen in 15% of KADCYLA patients, compared to 0.4% of lapatinib + capecitabine patients
Grade ≥3 increased transaminases seen in 8.0% of KADCYLA patients, compared to 2.5% of lapatinib + capecitabine patients
Grade ≥3 diarrhea seen in 1.6% of KADCYLA patients, compared to 21% of lapatinib + capecitabine patients
Grade ≥3 peripheral neuropathy seen in 2.2% of KADCYLA patients, compared to 0.2% of lapatinib + capecitabine patients
Grade ≥3 vomiting seen in 0.8% of KADCYLA patients, compared to 4.5% of lapatinib + capecitabine patients
Grade ≥3 anemia seen in 4.1% of KADCYLA patients, compared to 2.5% of lapatinib + capecitabine patients
Grade ≥3 stomatitis seen in 0.2% of KADCYLA patients, compared to 2.5% of lapatinib + capecitabine patients
Grade ≥3 hypokalemia seen in 2.7% of KADCYLA patients, compared to 4.7% of lapatinib + capecitabine patients
Grade ≥3 neutropenia seen in 2.0% of KADCYLA patients, compared to 4.3% of lapatinib + capecitabine patients
This image shows recommended dosing for KADCYLA: 3.6 mg/kg every 3 weeks.
Overview
This image shows the infusion schedule for KADCYLA in metastatic breast cancer.
Details
The initial infusion of KADCYLA in EBC takes 90 minutes plus an observation time of at least 90 minutes to monitor for infusion-related reactions. If prior infusions were well tolerated, subsequent infusions take 30 minutes plus an observation time of at least 30 minutes.
Treat until disease progression or unmanageable toxicity.
Overview
This image shows the dose reduction schedule for adverse reactions to KADCYLA.
Details
The starting dose for KADCYLA is 3.6 mg/kg. The first dose reduction for KADCYLA is 3 mg/kg. The second dose reduction for KADCYLA is 2.4 mg/kg. After that, discontinue KADCYLA.
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