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Help for Uninsured Patients

The Genentech® Access to Care Foundation (GATCF) was created to help patients who are uninsured—or who have been denied coverage for LUCENTIS® (ranibizumab injection) by their health plans. GATCF might be able to help those patients receive LUCENTIS treatment if they meet specific financial and medical criteria.

 

 


 

 

How do I get started?

To apply to GATCF, you must complete and submit the Statement of Medical Necessity (SMN) form and have your patient complete and submit a Patient Authorization and Notice of Release of Information (PAN) form.

The SMN can be submitted online via My Patient Solutions or downloaded from Forms and Documents.

 

When completing the SMN, be sure to complete all sections of the form.

 

 

Once we receive your patient’s information, LUCENTIS Access Solutions will contact the patient within 24 hours with further instructions. This may include verifying financial eligibility.

 

Additional GATCF Program details:

  • Patients are eligible for free medicine for 1 year; patients must reapply annually
  • Patient assistance support may be given before treatment or up to 1 year post-treatment
  • GATCF assists with the cost of LUCENTIS only, not the administration costs

 

GATCF has the right to modify or end this program at any time and to verify the accuracy of the information you submit.

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