Back To TOP

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.

 


 

 

Is my patient eligible?

For your patient to be eligible for help from GATCF, certain specific criteria must be met:

  • Your patient must have no health insurance or the health plan has denied coverage for LUCENTIS
  • Your patient’s annual household adjusted gross income must be $100,000 or less (special consideration may be given to patients with unique circumstances)
  • Your patient must meet medical criteria determined by the GATCF Clinical Advisory Board

 

 


 

 

How do I get started?

To apply to GATCF, the following forms must be completed and submitted in addition to the Statement of Medical Necessity (SMN) form and Patient Authorization and Notice of Release of Information (PAN) form.

 

  • Insurance attestation: required for each of your patient's insurance plans and serves as proof that the patient's insurance will not cover the prescribed Genentech therapy
  • Confirmation of infusion or injection: should be completed after each infusion or injection of an office-administered product

 

These forms can be submitted online via My Patient Solutions or downloaded from our Forms and Documents Center.

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

 

 

Only the information requested on these forms is required. Providing additional documents or information will delay processing.

 

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.