SPECIAL REPORT
The
Lucentis Commitment – Access Made Simple
RONALD
PARK, MD, MBA
As Peter K. Kaiser, MD, wrote in the previous
article, ranibizumab is anticipated to add to the armamentarium of options for neovascular
age-related macular degeneration (AMD). Genentech has worked for nearly a decade
on ranibizumab and we are pleased to now be working alongside retinal specialists
to make ranibizumab available to patients.
As ranibizumab enters the market, it is clear that the current
healthcare system has a number of issues (patients without insurance and patients
with inadequate insurance) that may create hurdles to accessing ranibizumab. Furthermore,
dealing with these issues can take valuable time away from physicians and their
staff. As someone who practiced medicine in Los Angeles in the 1990s, I personally
know how frustrating this can be. Now, as an employee of Genentech, I am pleased
to be part of a team introducing a suite of reimbursement and access support services
to help address these hurdles for patients on ranibizumab. We call this the "Lucentis
Commitment — Access Made Simple."
A HISTORY OF COMMITMENT
TO HEALTH CARE
The Lucentis Commitment is built on Genentech's
experience with a wide range of complex issues associated with office-injected or
infused biologics. Since our founding 30 years ago, we have launched 14 biologic
products in 8 different specialties, including human growth hormone in pediatrics
(Nutropin), tissue-plasminogen activator in cardiology (Activase), anti-HER2 antibody
in oncology (Herceptin), and anti-IgE antibody in allergic asthma (Xolair). With
each of these drugs, we have gained experience in assisting our customers with reimbursement
and access issues.
We have now taken that experience and tailored it to the retinal
specialist community. To do so, we gathered input from retinal specialists and practice
managers. We are thankful for their time, and we hope the result is a suite of services
that will be helpful in addressing non-clinical hurdles for retinal specialists
and their patients with wet AMD.
PROGRAM OBJECTIVES
The following description provides a brief
overview of the three objectives of the Lucentis Commitment – Access Made
Simple program. These objectives are to:
1. Maximize patient access
2. Minimize reimbursement hassle
3. Address office inventory concerns
Maximize Patient Access
Our primary objective is to ensure that
all patients have access to our therapies. Given the wet AMD patient population
insurance characteristics, we anticipate that primary and supplemental insurance
will cover the majority of cost for most patients. However, we recognize there
are 2 groups of patients who may have difficulty with access — the uninsured
and those with high co-pays due to inadequate insurance.
Genentech has long recognized the needs of the uninsured and underinsured
populations. For the last 20 years, we have provided free product through the Genentech
Access to Care Foundation (GATCF) that provides assistance to eligible patients
who are uninsured or rendered uninsured due to payer denial. Last year alone, GATCF
helped 18 000 uninsured patients by providing approximately $200 million of free
product. GATCF will be available to provide ranibizumab to eligible patients who
meet its criteria (which include that the patient must have an annual adjusted gross
income of less than $75 000). We have also worked to make the paperwork and forms
as simple as possible for both physicians and patients.
The
other group of concern consists of underinsured patients, which may include those
with high co-pay plans such as Medicare patients without supplemental insurance.
For patients requesting assistance with their co-pays, we can help obtain information
on and contact an independent public charity that may be able to provide the necessary
financial assistance. Although the independent public charities ultimately make
the decision regarding assistance, Genentech is committed to supporting the mission
of these charities. Recently, Genentech donated more than $21 million to these charities
for various disease states so that they could provide financial assistance to eligible
patients who cannot access needed medical treatment due to high co-pay costs.
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*At
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Minimize Reimbursement Hassle
Genentech is committed to providing reimbursement
assistance, thereby helping to reduce the time offices spend on reimbursement. To
this end, Genentech has more than 100 people working on minimizing reimbursement
hassle and facilitating patient access to ranibizumab.
Furthermore, access to these services is designed to be as simple
as possible. One phone number is the gateway to the range of support services mentioned
in this article. Our single point of contact number is 1-866-724-9394 and is available
Monday through Friday, 9 am to 8 pm (EST). For those who prefer Web access, the
same services can be accessed at
www.lucentis.com.
Additionally, each retinal practice will have a dedicated, expert
case manager to provide reimbursement support. This person can help you and your
staff answer reimbursement questions, investigate patient insurance policy benefits,
confirm payer coverage requirements, and assist as appropriate with coverage denials
and appeals.
For certain accounts where in-office support would be appropriate,
Genentech has a dedicated group of Retina Business Account Managers (RBAMs), who
can work with your staff to provide patient-specific support with reimbursement,
billing, coding, and patient assistance. RBAMs are local reimbursement experts who
are not compensated on sales. Their goal is to simplify the distribution and reimbursement
process for your office.
Address Office Inventory Concerns
We understand that holding and managing
inventory of biologic drugs can be a challenge, and that many offices are concerned
about this. It is a concern that we have found to be common for specialties that
utilize office-injected/infused drugs.
To help address these issues, we have put in place a number of
measures as part of the Lucentis Commitment — Access Made Simple Program. In
particular, we have worked with our distributors to arrange 120-day invoice dating
until a permanent J-code is established, so that you will have time to receive reimbursement
after you use the drug. To minimize your inventory, all our distributors will offer
overnight shipping, so you will not need to carry more product than you intend to
use in the near-term. Finally, we offer a comprehensive spoilage program that will
rapidly replace broken or spoiled vials that may result from shipping or refrigeration
issues.
SUMMARY
We are very excited that ranibizumab will
be available to retinal specialists and their patients with wet AMD. At the same
time, we recognize the challenges posed by the non-clinical aspects of our healthcare
system and how those challenges may impede your ability to provide ranibizumab to
patients with wet AMD.
We hope you will find the Lucentis Commitment – Access Made
Simple program will assist you in dealing with these challenges. Our goal for this
program is to
help you spend your time caring for patients, and we hope
this program provides a positive means toward this worthy end.
Ronald Park, MD, MBA, is a director of Managed
Care and Customer Operations at Genentech in South San Francisco, Calif.
Retinal Physician, Issue: July 2006