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Genentech Access to Care Foundation (Lucentis)
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PO Box 2807
San Francisco, CA 94083
Phone
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800-232-0592
Fax:
888-727-7773
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Eligibility
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This program is intended for patients with no prescription coverage or have been denied coverage. Medicare PartD is determined case by case. Gross annual household income at or below $100,000. Must be treated by US licensed healthcare provider |
| Who Can Apply
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Doctor/Doctor's office starts process by filling out enrollment/statement of medical necessity forms. Application is received via fax, mail or download from website. Return application via fax or mail. |
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Required
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Diagnosis/Medical Criteria not disclosed. Doctor must complete and sign statement of medical necessity. Patient must complete Patient Authorization and Notice of Information Form available on website, attach proof of income. |
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Supply
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Amount/supply varies. Refill process and limit not specified. New application is to be completed yearly. |
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Ship To
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Ship to Doctor's office, hospital, or pharmacy. |
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Note
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This program also provides copay assistance.
Contact program for Spanish application. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Lucentis Injection |
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