Available Financial Assistance Options
The Genentech Ophthalmology Co-pay Program
If eligible commercially insured patients need assistance with their drug and/or administration out-of-pocket costs, the Genentech Ophthalmology Co-pay Program may help.
To get started, call (855) 218-5307 or visit EyeOnCopay.com.
Eligibility criteria and benefit limits apply. Not valid for patients using federal or state government programs to pay for their medicine and/or administration of their Genentech medicine. Patients must be taking the Genentech medicine for an FDA-approved indication. Please visit the Co-pay Program website for the full list of Terms and Conditions.
Referrals to Independent Co-pay Assistance Foundations
For eligible patients with commercial or public health insurance, LUCENTIS Access Solutions offers referrals to independent co-pay assistance foundations that may be able to help.
Independent co-pay assistance foundations have their own rules for eligibility. Genentech has no involvement or influence in independent foundation decision-making or eligibility criteria and does not know if a foundation will be able to help your patient. We can only refer your patient to a foundation that supports their disease state. This information is provided as a resource for you. Genentech does not endorse or show preference for any particular foundation. The foundations in this list may not be the only ones that might be able to help your patient.
The Genentech Patient Foundation
If patients don’t have health insurance coverage or have financial concerns and meet eligibility criteria, they may be able to get Genentech medicine at no cost from the Genentech Patient Foundation.
Call (888) 941-3331 to speak with a live Foundation Specialist. We offer support in many different languages.
To be eligible for free Genentech medicine from the Genentech Patient Foundation, insured patients who have coverage for their medicine should try to pursue other forms of financial assistance, if available, and meet certain income requirements. Uninsured patients and insured patients without coverage for their medicine must meet a different set of income requirements. Genentech reserves the right to modify or discontinue the program at any time and to verify the accuracy of information submitted.
Reimbursement Support
LUCENTIS Sample Coding
This coding information may assist you as you complete the payer forms for LUCENTIS. These resources are provided for informational purposes only. Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding for single-use vials and wastage.
Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any item or service.
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Complete and submit a form electronically.
Appeals
If your patient’s health insurance plan has issued a denial, your Field Reimbursement Manager (FRM) or LUCENTIS Access Solutions Specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements.
If a plan issues a denial:
The denial should be reviewed, along with the health insurance plan’s guidelines, to determine what to include in your patient’s appeal submission
Your FRM or LUCENTIS Access Solutions Specialist has local payer coverage expertise and can help you determine specific requirements for your patient
A sample appeal letter and additional considerations are available in Resources.
Appeals cannot be completed or submitted by LUCENTIS Access Solutions on your behalf.
Coverage Resources
Benefits Investigations
LUCENTIS Access Solutions can conduct a benefits investigation (BI) to help you determine if LUCENTIS is covered, if prior authorizations (PAs) are required, which specialty pharmacy (SP) the health insurance plan prefers and if financial assistance might be needed.
Potential outcomes of a BI:
- Treatment is covered
- PA is required
- Treatment is denied
Both the Prescriber Service Form and the Patient Consent Form must be received before LUCENTIS Access Solutions can begin helping your patient.
Forms can be downloaded from Enrollment or submitted online via My Patient Solutions®.
A sample appeal letter and additional considerations are available in Resources.
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.
Prior Authorization
LUCENTIS Access Solutions can help you identify if a prior authorization (PA) is necessary and offer resources as you request it for your patient. Both the Prescriber Service Form and the Patient Consent Form must be received before LUCENTIS Access Solutions can begin helping your patient.
Forms can be downloaded from Enrollment or submitted online via My Patient Solutions®.
If your patient’s request for a PA is not granted, your Field Reimbursement Manager (FRM) or LUCENTIS Access Solutions Specialist can work with you to determine your next steps. You can find more tips like this in Resources.
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.
Enrollment
To enroll in Genentech patient support services, both you and your patient will need to complete the required forms.
For Patients: (choose one)
- Patient Consent Form - English
- Patient Consent Form - Spanish
For Providers: (choose one)
- Prescriber Service Form (to enroll patients in LUCENTIS Access Solutions)
- Prescriber Foundation Form (to enroll eligible patients into the Genentech Patient Foundation only)
Enroll patients online and manage service requests using My Patient Solutions®
Both forms must be received before Genentech can begin helping your patient. Only the information requested on these forms is required. Providing unrequested documents or information will delay processing.
Distribution
Specialty Pharmacies
LUCENTIS Access Solutions works with specialty pharmacies (SPs) to help patients receive their medicines.
An SP may provide the following services:
- Reimbursement resources
- Clinical services to support patients throughout their treatment
- The ability to manage the specialty handling and shipping needs linked with many specialty therapies
You can work with your preferred SP or contact LUCENTIS Access Solutions to learn which SP the patient’s health insurance plan requires.
Genentech does not influence or advocate the use of any one specialty distributor or SP. We make no representation or guarantee of service or coverage of any item.
Buy and Bill
With buy and bill, the practice purchases the medication in advance, then bills the patient’s health insurance plan for reimbursement. The practice is responsible for storing and handling the drug, as well as collecting the patient’s co-pay for both the drug and its administration. With buy and bill, practices can maintain a stock of the drug, giving them the flexibility to treat patients when clinically appropriate.
Genentech has contracted with a network of authorized specialty distributors to service practices choosing to purchase LUCENTIS through the buy and bill model. Customers can purchase LUCENTIS through authorized specialty distributors and wholesalers that have made a commitment to product integrity. These partners have agreed to distribute only products purchased directly from Genentech and not to distribute LUCENTIS through secondary channels.
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| Dakota Drug | 866-210-5887 | 763-421-0661 | www.dakdrug.com/ContactUs.aspx |
| DMS Pharmaceutical | 877-788-1100 | 847-518-1105 | www.dmspharma.com/contact-us |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| McKesson Plasma and Biologics (MPB) | 877-625-2566 | N/A | www.mckesson.com/Pharmaceutical-Distribution/Plasma-Biologics/ |
| Morris & Dickson | 800-388-3833 | 318-524-3096 | www.morrisdickson.com/products/specialty |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| McKesson Specialty Health (McKesson Specialty Care Distribution Corporation) | 800-482-6700 | N/A | www.mckesson.com/specialty/ |
| Metro Medical (Cardinal Health) | 800-768-2002 | 615-256-4194 | www.metromedicalorder.com |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| Besse Medical (Cencora) | 800-543-2111 | 800-543-8695 | www.besse.com/home |
| Cardinal Health Specialty Distribution | 866-677-4844 | N/A | www.cardinalhealth.com/en/solutions/specialty-distribution.html |
| CuraScript SD (Priority Health) | 877-599-7748 | 800-862-6208 | curascriptsd.com/Contact-Us |
| McKesson Specialty Health (McKesson Specialty Care Distribution Corporation) | 800-482-6700 | N/A | www.mckesson.com/specialty/ |
| Distributor | Telephone | Fax | Web Orders |
|---|---|---|---|
| Cardinal Health Puerto Rico | 787-625-4200 | N/A | cardinalhealth.pr/ |
| Pharmacy | Telephone | Fax | Web Orders |
|---|---|---|---|
| AcariaHealth | 800-511-5144 | 877-541-1503 | www.acariahealth.com |
| Accredo | 888-608-9010 | 888-302-1028 | www.accredo.com |
| AleraCare | 888-209-8874 | N/A | www.aleracare.com/ |
| Alivia Specialty Pharmacy (Puerto Rico) | 787-979-2023 | N/A | www.aliviahealth.com/specialty-pharmacy |
| BioMatrix Specialty Pharmacy | 888-662-6779 | N/A | www.biomatrixsprx.com/ |
| BioPlus Specialty Pharmacy | 866-514-8082 | 800-269-5493 | www.bioplusrx.com |
| Birdi (aka Elixir, formerly Envision) | 877-437-9012 | N/A | www.elixirsolutions.com/ |
| CareMed Pharmaceutical Services (Sorkins Rx Ltd) | 877-227-3405 | 877-542-2731 | www.caremedps.com |
| CenterWell Specialty Pharmacy (formerly Humana Specialty Pharmacy) | 800-486-2668 | N/A | www.centerwellpharmacy.com/ |
| CVS Specialty | 800-237-2767 | 800-323-2445 | www.cvsspecialty.com |
| Kalamazoo Long Term Care Pharmacy | 269-388-4850 | 269-388-4870 | kltcpharmacy.com/ |
| Kroger Specialty Pharmacy | 855-802-3230 | 888-315-3270 | www.krogerspecialtypharmacy.com/ |
| Prime Therapeutics (Magellan) | 855-457-0007 | N/A | https://www.primetherapeutics.com/ |
| MC-RX (Medical Centre Specialty Pharmacy) | 855-828-1484 | N/A | www.mc-rx.com/ |
| Nufactor | 800-323-6832 | N/A | www.nufactor.com/ |
| Optima Infusion Pharmacy (Puerto Rico) | 787-883-5959 | 787-883-6042 | www.optimahealthpr.com/ |
| Optum Specialty Pharmacy | 855-427-4682 | 877-342-4596 | specialty.optumrx.com/ |
| Perform Specialty | 855-287-7888 | 844-489-9565 | www.performspecialty.com/ |
| Pruitt Health Pharmacy Services | 678-533-6459 | N/A | pruitthealth.com/microsite/facilityid504 |
| Publix Specialty Pharmacy | 855-797-8254 | N/A | www.publix.com/pharmacy/pharmacy-services/specialty |
| Reliance Rx (Specialty Pharmacy Management) | 716-929-1000 | 716-532-7360 | www.reliancerxsp.com/ |
| Special Care Pharmacy (Puerto Rico Only) | 787-783-8579 | 787-783-2951 | specialcarepr.com |
| Specialty Pharmacy Service (SPS) (Puerto Rico Only) | 787-704-2025 | 787-704-2027 | www.spscaguas.com |
| Value Specialty Pharmacy (Value Drug Company) | 800-252-3786 | 814-944-3146 | www.valuedrugco.com |
| Walgreens Specialty Pharmacy | 888-782-8443 | N/A | www.walgreens.com/topic/pharmacy/specialty-pharmacy.jsp |
Note: Pharmacies primarily serving the patients of particular health systems or health plans are not included in this list.
We work with these authorized distributors and specialty pharmacies to provide LUCENTIS to patients and the prescribers.
Genentech does not influence or advocate the use of any one specialty distributor or specialty pharmacy. We make no representation or guarantee of service or coverage of any item.
Spoilage Replacement Program
To learn more about the Genentech Spoilage Replacement Program, click here.