Appeals

If your office has prescribed LUCENTIS^® (ranibizumab injection), but your patient's insurer has denied coverage, you can appeal that decision. LUCENTIS^® Access Solutions and the LUCENTIS specialty pharmacies might be able to help as you resolve the situation. Here is what you can do.

Understand why the request or claim has been denied. This should be in the insurer's letter of denial or the patient's Explanation of Benefits (EOB) letter.
Contact a specialty pharmacy (SP) or LUCENTIS Access Solutions to guide you in the process as you put together the appeal.
- If the patient is already working with an SP, it will provide support throughout the appeals process
- If your patient is not working with an SP, refer the case to LUCENTIS Access Solutions for appeal support. We provide support for patients who aren't being helped through an SP
Complete and submit the required forms and documents to the insurer before the appeal deadline. LUCENTIS Access Solutions or the SP can provide information about this process.

An appeal may also be pursued without the SP or LUCENTIS Access Solutions. Here is what you can do.

Understand why the request or claim has been denied. This should be in the insurer's letter of denial or the patient's EOB letter.
Gather the appeal information for LUCENTIS. Use the resources on this site to help you gather the documents and information you need for a successful appeal.
Complete and submit the required forms and documents to the insurer before the appeal deadline.
If the insurer approves the appeal, it will notify your office. LUCENTIS can then be dispensed to your patient. You may also purchase LUCENTIS, administer it and bill it. If the appeal is denied, contact the SP or LUCENTIS Access Solutions for more information. Keep copies of all documents related to the case before referring to the SP or us - including the denial letter.

Please note: This description of the appeals process is for informational purposes only. The submission of an appeal is the responsibility of the patient and your office. LUCENTIS Access Solutions makes no representation or guarantee concerning reimbursement or coverage for any service or item. Each health insurer and patient case may require different information. Please review each denial and the health insurer's guidelines to determine what to include in your patient's appeal package. Your Field Reimbursement Manager has unique health plan-specific knowledge and can help you determine the specific requirements for your patient.

The flow chart seen here illustrates the denials and appeals process.

Who is LUCENTIS for?

LUCENTIS^® (ranibizumab injection) is a prescription medicine for the treatment of patients with Wet Age-Related Macular Degeneration (AMD) and Macular Edema Following Retinal Vein Occlusion (RVO).

What important safety information should I know about LUCENTIS?

LUCENTIS is a prescription medication given by injection into the eye, and it has side effects. Some LUCENTIS patients have had detached retinas and serious eye infections. LUCENTIS should not be used in patients who have an infection in or around the eye or are allergic to LUCENTIS or any of its ingredients. LUCENTIS patients have had increases in eye pressure within 1 hour of an injection. Serious side effects also include inflammation inside the eye, and rarely, problems related to the injection procedure, such as cataracts. Although not common, some LUCENTIS patients have had strokes or heart attacks. If your eye becomes red, sensitive to light, painful, or has a change in vision, you should call or visit your eye doctor right away. Ask your doctor if you have questions or want more information.

For additional safety information, please talk to your doctor and see the LUCENTIS full prescribing information.

LUCENTIS^® is a registered trademark and the Access Solutions logo and the Access Solutions Treatment made possible logo are trademarks of Genentech USA, Inc.