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LUCENTIS Co-pay Card

The LUCENTIS Co-pay Card Program can help reduce the out-of-pocket costs for eligible LUCENTIS patients with commercial insurance, regardless of income.

 


 

 

Who is eligible?

 

 
  • Treated with LUCENTIS for: – Diabetic Macular Edema (DME) – Neovascular (Wet) Age-related Macular Degeneration (AMD) – Macular Edema following Reinal Vein Occlusion (RVO) IMPORTANT NOTE: Patients must be treated with the dose FDA-approved for their indication in order to be eligible.

     

  • Covered by commercial insurance only
  • Not eligible if LUCENTIS prescriptions are paid in part or full by any state or federally funded programs such as Medicare or Medicaid, Medicare Advantage, Managed Medicaid, Veterans Affairs (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

     

     

     

  • Reside in the United States or Puerto Rico
 

 

 


 

 

What does the program cover?

 

 
Program benefit
  • Up to $5000 per year of the patient's co-pay or co-insurance for LUCENTIS or up to $1500 per year if household income is more than $100,000
Patient's responsibility
  • The first $5 of their co-pay or co-insurance for LUCENTIS, and any additional out-of-pocket costs exceeding $1000 per month, up to the maximum program benefit
  • Other patient costs that might apply, such as co-pays for office visits or administration
 

 

To enroll in the LUCENTIS Co-Pay Card Program, call (855) 218-5307 from 9 a.m. to 8 p.m. ET, Monday through Friday, or go to www.LucentisCoPayCard.com.

Learn More About
Lucentis
  • LEARN about treatment with LUCENTIS
  • FIND the right patient assistance program with our Compass for Patient Access tool
  • LEARN HOW the LUCENTIS Co-pay Card can help with the out-of-pocket costs for LUCENTIS
  • Download: new forms for enrollment in GATCF
  • Form Statement of Medical Necessity
  • Form Patient Authorization and Notice of Release of Information

LUCENTIS Indications and Important Safety Information

INDICATIONS

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)

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).

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.

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 see LUCENTIS full Prescribing Information