top image description bottom

Questions? Read on, or speak with
a live representative at (855) 218-5307

Providers, click here to see provider-specific frequently asked questions.
Q.
How long does it take to be approved for the program?
A.
The program will typically process enrollment and determine patient eligibility in 1 business day.
Q.
Are there any benefit limits to this program?
A.
Within each 12-month period, patients have a maximum program benefit of $10,000.
Q.
Does the program cover the cost of administering LUCENTIS?
A.
The program covers only the patient's "out-of-pocket expenses" for LUCENTIS (ranibizumab injection) itself. This may also be called "co-pay," "co-insurance," "cost-sharing," or "uncovered expense." It is the portion of the cost for LUCENTIS that is not covered by insurance.
Q.
Does the program cover the cost of other medications or diagnostics related to the office visit?
A.
No, the program does not apply to other costs related to office visits, diagnostic tests, administration, or other treatments.
Q.
Can the patients use the Lucentis Co-Pay Card program for assistance with previous co-pays?
A.
Patients should enroll in the program prior to receiving LUCENTIS. The program will also cover previous co-pays within the last 120 days.
Q.
Does the program cover a deductible if one is required by the primary insurance?
A.
The program may cover a portion of the deductible that is applied to LUCENTIS by the primary insurance. The program covers any dollar amount over the patient's initial $5 out-of-pocket cost for LUCENTIS, up to a yearly maximum of $10,000.
Q.
Is proof of income required?
A.
Proof of income is not required at enrollment; however, the patient may be asked to submit proof of income at a later date.

Provider-specific questions

 

Q. How should practices submit requests to the program? 

A. Practices can submit a co-pay request using healthcare standard 837 electronic transactions or paper-based CMS 1500 forms. Once a practice enters the LUCENTIS Co-Pay Card program into its billing system as secondary payer, co-pay requests will be processed the same as all other secondary payer requests. Co-pay request to the LUCENTIS Co-Pay Card program must be submitted within 365 days following administration. 

Q. What if my patient has both primary and secondary commercial insurance?

A. The eligible patient's insurance coverage should be exhausted before a request is submitted to the program. For example, if a patient has primary and secondary insurance, first submit a request to the primary insurer, then a secondary request to the secondary insurer, and then a co-pay request along with both explanation of benefits (EOBs) to the LUCENTIS Co-Pay Card program.

Q. How long will it take for the program to process requests?
A. Once the patient's EOB and co-pay request are submitted, practices can usually expect to be reimbursed within 10 to 15 business days. In general, requests submitted electronically take less time to process than paper-based requests.
Q. Can patients get treatment from more than one doctor's office?
A. Yes. To receive LUCENTIS Co-Pay Card program benefits, patients must supply each practice with their program ID number, which can be found on their card or by calling (855) 218-5307 from 9 AM to 8 PM ET, Monday to Friday.
Q. What is the Lucentis Patient Support program?
A.The LUCENTIS Patient Support program is a free educational program developed by Genentech. The program provides support and helpful information by mail and email for people on LUCENTIS therapy. For more information, please visit https://www.lucentis.com/lucentis/join-form.html. 
  
Q.
If patients receive bilateral injections, will they pay the $5 co-pay once or twice during the month?
A.
If the patient receives bilateral injections on the same day and both injections are billed on the same request form, the patient will have one $5 co-pay. If the patient receives injections on separate days and the injections are billed separately, the patient will have a $5 co-pay for each injection.
 
Q.
Will patients enrolled prior to the implementation date receive the updated program benefits?
A.
Yes. All commercially insured patients enrolled or re-enrolled into the LUCENTIS Co-pay Card program will receive the updated program benefits, provided they are commercially insured and eligible for the Co-pay Card program.
Q. How do I ensure that the annual maximum benefit for current enrolled patients with a household income greater than $100k increases from $1,500 to $10,000 effective June 8, 2015?
ANo action is needed by office -patients are already eligible for the increased amount.
Q. Does this change mean the patients are re-enrolled into the LUCENTIS Co-pay Card program starting June 1?    
ANo. Modification to the benefit structure does not constitute re-enrollment -patients will continue to be on their existing 12-month benefit cycle.
Q. Does the annual maximum benefit change if a patient has bi-lateral (two eye) disease?   
A No. Regardless of which eyes are affected, patients can receive up to $10,000 of co-pay benefit.                    
Q. Is direct deposit available as an option for receiving co-pay reimbursements?   
A Yes.