Welcome to the LUCENTIS Co-Pay Card Program

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?

LUCENTIS Co-Pay Card program Overview

 Annual benefit

  • Up to $10,000 per year of the patient’s co-pay or co-insurance for LUCENTIS, regardless of income*

 Patient’s responsibility

  • The first $5 of their co-pay or co-insurance for each visit
  • The Co-pay Card program then covers out-of-pocket costs for LUCENTIS, up to $10,000 per year

When to enroll
  • Patient should enroll prior to receiving treatment with LUCENTIS
  • If there are delays with enrollment and therapy has already been administered, patients must enroll within 120 days of treatment 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.

Which patients are eligible?

  • 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
IMPORTANT NOTE: Patients must be treated with the dose FDA approved for their indication in order to be eligible.
  • Covered by commercial insurance only
  • Patients are not eligible if they have government insurance such as Medigap, Medicare, Medicaid, Veterans Affairs (VA), Department of Defense (DoD), and TRICARE.
  • Does not currently receive assistance from the Genentech® Access to Care Foundation (GATCF) or other co-pay assistance foundations for LUCENTIS
  • Resides in U.S. or Puerto Rico and 18 years of age or older.

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.

Along with EOBs from a primary payer (and secondary payer, if applicable), you will need the following information when you submit a request to the LUCENTIS Co-Pay Card program:

What are the request submission guidelines?

  • EDI 837 for electronic submission
  • HCFA 1500 for paper-based submission, which must be faxed to (855) 320-0457
Payer Number
Required for EDI837
Electronic Submission
  • 05587 (Payer number updated as of September 23, 2013 for electronic processing; formerly 48117)
  • Payer number not required for HCFA 1500 faxed submissions
Group Number
  • AZ0011
Member ID
  • Found on the patient's enrollment confirmation letter or the patient's co-pay card
NDC Code
  • 50242-080-01 (0.5mg vial of Lucentis)
  • 50242-082-01 (0.3mg vial of Lucentis)
  • 50242-080-03 (0.5mg PFS of Lucentis)
Product J Code
  • J2778


LUCENTIS® (ranibizumab injection) is indicated for the treatment of patients with: 
  • Neovascular (wet) age-related macular degeneration (wAMD)
  • Myopic choroidal neovascularization (mCNV)
  • Macular edema following retinal vein occlusion (RVO)
  • Diabetic macular edema (DME)
  • Diabetic retinopathy (Non Proliferative DR (NPDR) and Proliferative DR (PDR)) with diabetic macular edema (DME)                                                                                                     



LUCENTIS is contraindicated in patients with ocular or periocular infections or known hypersensitivity to ranibizumab or any of the excipients in LUCENTIS.

Intravitreal injections, including those with LUCENTIS, have been associated with endophthalmitis, retinal detachment, and iatrogenic traumatic cataract.

Increases in intraocular pressure have been noted both pre-injection and post-injection with LUCENTIS.

Although there was a low rate of arterial thromboembolic events (ATEs) observed in the LUCENTIS clinical trials, there is a potential risk of ATEs following intravitreal use of VEGF inhibitors. ATEs are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause).

Fatal events occurred more frequently in patients with DME and DR at baseline treated monthly with LUCENTIS compared with control. Although the rate of fatal events was low and included causes of death typical of patients with advanced diabetic complications, a potential relationship between these events and intravitreal use of VEGF inhibitors cannot be excluded.

In the LUCENTIS Phase III clinical trials, the most common ocular side effects included conjunctival hemorrhage, eye pain, vitreous floaters, and increased intraocular pressure. The most common non-ocular side effects included nasopharyngitis, headache, influenza, sinusitis, cough, and nausea.

For additional safety information, please see  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.

Please note: If at any time you do not wish to receive any further e-mails, mailings, or other communications about the Genentech LUCENTIS Co-pay Card, please call (855)218-5307  from 8AM-8PM EST, Monday to Friday, and speak with a live agent.Click here to see frequently asked questions about the LUCENTIS Co-Pay Card program.