Welcome to the LUCENTIS Co-Pay Card Program


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?

 Program Benefit

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

 Patient  Responsibility

  • The first $5 of their co-pay or co-insurance for LUCENTIS. The Co-Pay Card Program covers any additonal out-of-pocket costs, up to $10,000 per year.

 

*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)
    • 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
  • Patient not eligible if LUCENTIS prescriptions are paid in part or full by any state or federally funded programs, such as Medicare or Medicaid, Medigap, Medicare Advantage, Managed Medicaid, Veterans Administration (VA), Department of Defense (DoD), or 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 claim to the LUCENTIS Co-Pay Card Program:

What are the claim submission guidelines?

Format
 
  • 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
Number
  • 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)
Product J Code
  • J2778

Indication

LUCENTIS® (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.Fatal events occurred more frequently in patients with DME and DR at baseline treated monthly with LUCENTIS compared with control.

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. 

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 Conditions  

By using 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. It is not valid for patients who are Government beneficiaries or 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 become Government beneficiaries during their enrollment period will no longer be eligible for the program as of the date they become a Government beneficiary.

This Co-pay Card program is not health insurance or a benefit plan. Distribution or use of the Co-pay 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 reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs (such as: GATCF or any other charitable organization) that reimburse the patient 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 reimburse for all or any part of the benefit received by the receipient through the offer.

The Co-pay Card will be accepted by the 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-expences for each treatmant. This Co-pay Card is only avaialable with a valid prescription and can not 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 parties, pharmacies, physician offices and hospitals are obligated to inform third-party payers about the use of 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, this program shall expire on or before July 1,2017.

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 ammend 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 9 AM-8PM ET, Monday to Friday, and speak with a live agent.Click here to see frequently asked questions about the LUCENTIS Co-Pay Card Program.