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Enrolling in the LUCENTIS Co-Pay Card Program is Fast and Easy

The LUCENTIS Co-Pay Card Program can help reduce the out-of-pocket costs* patients eligible to receive LUCENTIS (ranibizumab injection) with commercial insurance, regardless of income.

What does the program cover?

Program may cover
 
  • Up to $10,000 per year of the patient's co-pay or co-insurance for LUCENTIS, regardless of income*
The patient’s
responsibility
 
  • The patient pays the first $5 of the patient's co-pay or co-insurance for each visit
  • The Co-pay Card Program covers any additional out of pocket costs for LUCENTIS, up to $10,000 per year
When to enroll
  • Make sure to enroll prior to receiving treatment with LUCENTIS
  • If the patients were already treated with LUCENTIS, the patient have upto 120 days to enroll in order to receive the benefits of the program

 *The LUCENTIS Co-Pay Card Program does not cover costs for any other medication, procedure, or diagnostic.

The patients may be eligible if the following statements are true for the patients:

  • The patients are not receiving support from the Genentech® Access to Care Foundation (GATCF) or other co-pay foundations for LUCENTIS.

  • The patients are being treated with LUCENTIS for:

    • Neovascular (wet) age-related macular degeneration (wAMD)
    • Myopic choroidal neovascularization (mCNV)
    • Macular edema following retinal vein occlusion (RVO)
    • Diabetic macular edema (DME)
    • Diabetic retinopathy (DR) with DME
  • The patients have "commercial" or "private" insurance.

    Patients using Medicare, Medicaid or any other Government funded program to pay for their medications are not eligible. Patients who start utilizing their Government coverage during their enrollment period will no longer eligible for the program.

  • The patient’s insurance covers LUCENTIS but requires the patient to pay for a part of the cost.

    This may be called "out-of-pocket," "co-pay," "co-insurance," or "uncovered expense."

  • The patient lives in the United States or Puerto Rico and is 18 years of age or older.

Please see the terms and conditions listed below.
If all of the statements are true for the patients, click the button to enroll.

The patient will need the following information to enroll by phone or online:

  • Contact information for the patient and the patient’s doctor
  • The patient’s insurance information

Patients who are ineligible for the LUCENTIS Co-Pay Card program may be eligible for other types of patient support. Please call LUCENTIS Access Solutions® at (866) 724-9394 for details.

Who is LUCENTIS for?

LUCENTIS® (ranibizumab injection) is a prescription medicine for the treatment of patients with wet age-related macular degeneration (wAMD), macular edema following retinal vein occlusion (RVO), myopic choroidal neovascularization (mCNV), diabetic macular edema (DME), or diabetic retinopathy (DR) with DME.

What important safety information should I know about LUCENTIS?

You should not use LUCENTIS if you have an infection in or around the eye or are allergic to LUCENTIS or any of its ingredients. LUCENTIS is a prescription medication given by injection into the eye, and it has side effects. Some LUCENTIS patients have had detached retinas and serious eye infections. If your eye becomes red, sensitive to light, or painful, or if you have a change in vision, call or visit your eye doctor immediately. Some LUCENTIS patients have had increased eye pressure before and within 1 hour of an injection. Serious side effects also include inflammation inside the eye and, rarely, problems related to the injection procedure, such as cataracts. Uncommonly, LUCENTIS patients have had serious, sometimes fatal, problems related to blood clots, such as heart attacks or strokes. The most common eye-related side effects are increased redness in the white of the eye, eye pain, small specks in vision, and increased eye pressure. The most common non–eye-related side effects are nose and throat infections, anemia and nausea. Ask your doctor if you have questions or want more information.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.

For additional safety information, please talk to your doctor and see the LUCENTIS full prescribing information.
  

Consolidated Terms and Conditions

By using the LUCENTIS Co-pay Card program, the patient acknowledges and confirms that at the time of usage, (s)he is currently eligible and meet the criteria set forth in the terms and conditions described.

This Co-pay Card is valid ONLY for patients with commercial (private or non-governmental) insurance. Patients using Medicare, Medicaid or any other government funded program to pay for their medications are not eligible. Patients who start utilizing their Government coverage during their enrollment period will no longer be eligible for the program.

This Co-Pay Card program is not health insurance or a benefit plan. Distribution or use of the Co-pay Card does not obligate use or continuing use of any specific product or provider. Patient or guardian is responsible for reporting the receipt of all Co-pay Card program benefits or reimbursement received, to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Co-pay Card program, as may be required.

The Co-pay Card is not valid for medications the patient receives for free or that are eligible to be reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs (such as: GATCF or any other charitable organization) that reimburse the patient in part or for the entire cost of his/her medication. Patient, guardian, pharmacist, prescriber and any other person using the Co-pay Card agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer.

The Co-pay Card will be accepted by participating pharmacies, physician offices or hospitals. To qualify for the benefits of this Co-pay Card program, the patient may be required to pay out-of-pocket expenses for each treatment. Once enrolled, this Co-Pay Card program will not honor claims with date of service or medication dispensing that precede program enrollment by more than 120 days. This Co-pay Card is only available with a valid prescription and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Use of this Co-pay Card must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, pharmacies, physician offices and hospitals are obligated to inform third-party payers about the use of the Co-pay Card as provided for under the applicable insurance or as otherwise required by contract or law. The Co-pay Card may not be sold, purchased, traded or offered for sale, purchase or trade. The Co-pay Card is limited to 1 per person during this offering period and is not transferable. This program expires within 12 months from enrollment. This program is not valid where prohibited by law. For Massachusetts’ residents, the Co-pay Card is not valid for any prescription drug that has an AB rated generic equivalent as determined by the United States Food and Drug Administration. For Massachusetts’ residents, this program shall expire on or before July 1, 2019

The patient or their guardian must be 18 years or older to receive Co-pay Card program assistance. This Co-pay Card program is: (1) Void if the card is reproduced; (2) Void where prohibited by law; (3) only valid in the United States and Puerto Rico; and (4) only valid for Genentech products. Healthcare providers may not advertise or otherwise use the program as a means of promoting their services or Genentech’s products to patients. Genentech, Inc. reserves the right to rescind, revoke, or amend the program without notice at any time.