The LUCENTIS Co-Pay Card Program can help reduce the out-of-pocket costs* for eligible LUCENTIS patients with commercial insurance, regardless of income.
What does the program cover?
*The LUCENTIS Co-Pay Card Program does not cover costs for any other medication, procedure, or diagnostic.
Which patients are eligible?†
†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 claim to the LUCENTIS Co-Pay Card Program:
What are the claim submission guidelines?
|Payer Number |
Required for EDI837
|Member ID |
|Product J Code|
IndicationLUCENTIS® (ranibizumab injection) is indicated for the treatment of patients with:
- Neovascular (wet) age-related macular degeneration (wAMD)
- 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)
IMPORTANT SAFETY INFORMATION
LUCENTIS is contraindicated in patients with ocular or periocular infections or 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 nonocular side effects included nasopharyngitis, headache, influenza, sinusitis, cough, and nausea.
For additional safety information, please see the LUCENTIS full prescribing information.
CONSOLIDATED TERMS AND CONDITIONSBy using the LUCENTIS Co-pay Card program, the patient acknowledges and confirms that at the time of usage, they are currently eligible and meet the criteria set forth in the terms and conditions described. This Co-pay Card is valid ONLY for patients with private insurance or cash-paying patients. It is not valid for patients whose prescription drugs are covered, in whole or in part, under Medicaid, Medicare, a Medicare Part D or Medicare Advantage plan, TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan, or any other state or federal healthcare program. Patients who move from commercial to federally funded insurance will no longer be eligible for the program. This card 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 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 prescriptions that are eligible to be reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs (e.g.: GATCF) that reimburse you for the entire cost of your prescription drugs. 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 card will be accepted only at participating pharmacies. In order to qualify for this Co-pay Card, the patient may be required to pay certain out-of-pocket expenses for each treatment. 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. 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. For Massachusetts' residents, this program shall expire on or before July 1, 2015 and is not valid where prohibited by law.
You must be 18 years or older to receive Co-pay assistance for yourself or a minor. This Co-pay Card program is: (1) Void if the card is reproduced; (2) Void where prohibited by law; (3) good only in the United States and Puerto Rico; and (4) good only 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. Company reserves the right to rescind, revoke, or amend the program without notice at any time.
Click here to see frequently asked questions about the LUCENTIS Co-Pay Card Program.