Bringing patient treatment and practice solutions together

We are committed to helping patients get the medicine they need

LUCENTIS Access Solutions

Your resource for helpful access and reimbursement support after LUCENTIS is prescribed.

My Patient Solutions®

An online tool to help you enroll patients in LUCENTIS Access Solutions and manage your service requests.

Genentech Spoilage Replacement Program

Detailed instructions that explain how you may be able to replace spoiled LUCENTIS.

LUCENTIS Co-pay Program

Eligible patients with commercial insurance may pay as little as $5 per injection. Terms and conditions apply.

Independent Co-pay Assistance Foundations

LUCENTIS Access Solutions can refer patients to a foundation that might help them pay for treatment.

Genentech Patient Foundation

Helps patients in need, whether they have insurance or not.§

Enrollment Forms

LUCENTIS Access Solutions
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  • Prescriber Service Form

    The Prescriber Service Form replaces the SMN. It includes patient, insurance, and prescription information used when LUCENTIS Access Solutions contacts a patient's health insurance plan to determine his or her coverage.

  • Patient Consent Form

    The Patient Consent Form replaces the PAN. This form is signed and dated by your patient giving written permission for LUCENTIS Access Solutions to discuss his or her health information with you and the patient's health insurance plan.

  • Patient Consent Form – Spanish Translation

    A version of the Patient Consent Form for your Spanish-speaking patients.

The Prescriber Service Form and the Patient Consent Form are required for enrollment in LUCENTIS Access Solutions.

Each form may be completed and submitted electronically via My Patient Solutions.

Genentech Patient Foundation
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  • Prescriber Foundation Form

    Follow the instructions on this form to find out which patients may be eligible for assistance from the Genentech Patient Foundation and how to apply for support.

Other Important Documents

Considerations for Composing a Letter of Medical Necessity

This guide provides tips to help you draft a letter of medical necessity. A sample letter is also included for your reference.

Use the links below to find additional information to enclose in your letter.

FDA approval letter (Follow this link and search by the drug name)

Prescribing Information

Sample coding for LUCENTIS

 

Considerations for Composing a Sample Appeal Letter

This guide provides tips to help you draft an appeal letter. A sample letter is also included for your reference.

Use the links below to find additional information to enclose in your letter.

FDA approval letter (Follow this link and search by the drug name)

Prescribing Information

Sample coding for LUCENTIS

 

Fax Cover Letter

Use this cover sheet when faxing documents to LUCENTIS Access Solutions.

Educational Resources for Patients

LUCENTIS supports patients and families with materials that highlight the importance of staying on track with treatment. These pieces explain what patients may expect from LUCENTIS. They also provide answers to questions about wAMD, DR, and LUCENTIS.

 

Wet age-related macular degeneration (wAMD)
LUCENTIS wAMD Patient Staying on Track guide thumbnail
Staying on Track

This resource is a guide to wAMD for recently diagnosed patients and those assisting with their care. It will help them learn more about wAMD and what they may expect from treatment with LUCENTIS.

LUCENTIS wAMD Caregiver Guide thumbnail
Caregiver Guide

This guide helps caregivers understand what wAMD is and what it's like to have this condition. It also offers tips for how to provide additional support to someone who has wAMD.

Diabetic retinopathy (DR)
LUCENTIS DR Patient Brochure thumbnail
Patient Brochure

This brochure is the place to start for patients who have recently been diagnosed with diabetic retinopathy. It will help them learn more about DR and what they may expect from treatment with LUCENTIS.

LUCENTIS DR Care Partner Brochure thumbnail
Care Partner Brochure

This brochure explains DR to those assisting with care. It also offers advice and tools that care partner(s) can use to help manage this condition.

LUCENTIS DR Treatment Planner thumbnail
Treatment Planner

Diabetic retinopathy can get worse, even without symptoms. That’s why attending follow-up appointments with a Retina Specialist is important. This planner can help patients keep track of their appointments and any questions they may have.

 

This LUCENTIS Co-pay Program is valid ONLY for patients with commercial insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid, or any other federal or state government program to pay for their medications are not eligible.

Under the Program, the patient will pay a co-pay. After reaching the maximum Program benefit, the patient will be responsible for all Out-of-Pocket costs.

All participants are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. No party may seek reimbursement for all or any part of the benefit received through this Program. This Program is void where prohibited by law. Genentech reserves the right to rescind, revoke, or amend the Program without notice at any time. Additional eligibility criteria apply. See full terms and conditions at LUCENTISCopayProgram.com.

Genentech does not influence or control the operations or eligibility criteria of any independent co-pay assistance foundation and cannot guarantee co-pay assistance after a referral from Genentech Access Solutions. The foundations to which we refer patients are not exhaustive or indicative of Genentech’s endorsement or financial support. There may be other foundations to support the patient’s disease state.

§To be eligible for free Genentech medicine from the Genentech Patient Foundation, insured patients who have coverage for their medicine must have exhausted all other forms of patient assistance (including Genentech brand-specific co-pay cards and support from independent co-pay assistance foundations) and must meet certain financial criteria. Uninsured patients and insured patients without coverage for their medicine must meet different financial criteria.