The MACUGEN Access Program™ (MAP)

• MAP is a FREE patient support program - offered by the makers of MACUGEN^® (pegaptanib sodium injection)
  
  
• MAP has helpful counselors who will answer your questions
  
  
• MAP helps eligible patients find out how they may get access to MACUGEN treatment
  
  

MAP Offers the Following Services to Patients:

Reimbursement Counseling

MAP counselors will see if MACUGEN is covered by your insurance.

• If MACUGEN is not covered, the counselor will look for other coverage options
  
  
• These may include federal, state, and local assistance programs
  
  
• MAP counselors can also assist you and your doctor with the things your insurance might require, and can help with the authorization process, claim denials, and the appeals process
  
  

Patient Assistance Program (PAP)

The Patient Assistance Program is designed to assist medically and financially needy AMD patients who were prescribed MACUGEN by their doctor and who meet the program's enrollment criteria.

• You will be considered for PAP if:
  
  
• You do not have insurance coverage for MACUGEN
  
  
• Coverage cannot be found through insurance or other programs
  
  
• Coverage for MACUGEN is denied and appeals to your insurer fail
  
  

Patient Services

The MAP Hotline has been set up to help you with access to and coverage for MACUGEN. MAP counselors can:

• Let you know if you have coverage for MACUGEN
  
  
• Help you with prior authorization if needed
  
  
• Assist you with filing a claim
  
  
• Assist in the appeals process when a claim is denied or when MACUGEN is not covered
  
  
• Look for other coverage options if you are without coverage for MACUGEN
  
  

Learn More About MAP

MAP offers a Patient Assistance Program (PAP) that provides help to eligible patients based on their needs. You can call the MAP hotline and a program counselor will determine if you are eligible.

• PAP eligibility is based on:
  
  
• Lack of access to MACUGEN
  
  
• Family income
  
  
• U.S. residency
  
  
• Having a valid prescription for an FDA-approved use of MACUGEN signed by your doctor
  
  

Patients With Insurance:

What if you have insurance, but MACUGEN is not covered?

• If your insurer refused to cover or pay for MACUGEN, MAP counselors will assist you with the claims-appeals process
  
  
• You may be considered for the Patient Assistance Program
  
  
• You may be provided MACUGEN at no cost if you meet the established eligibility criteria
  
  

Patients Without Insurance:

What if you don’t have insurance?

• You may be considered for the Patient Assistance Program
  
  
• You may be provided MACUGEN at no cost if you meet the established eligibility criteria
  
  
• If you’re eligible, your doctor will receive up to a 1-year supply of MACUGEN for your treatment
  
  

What If You Are Still Without Insurance After 1 Year?

• Continued assistance may be provided after you reapply to the program.
  
  
• In this case, you must submit applications every
  12 months
  
  

How Do I Get Started With MAP?

To apply to MAP, you will need to start with the MAP enrollment form. This form lists what information you will need to provide before MAP can help you.

• You can get the form from your doctor, contact the MAP hotline, or download it by clicking the image below
  
  
• Your doctor will need to fill out the physician section of this form
  
  
• Be sure to complete all appropriate sections and sign the form
  
  
• You will need to return your filled-out enrollment form, along with the necessary items to MAP:
  
  

MAP
PO Box 220662
Charlotte, NC 28222-0662

You can print a copy of the enrollment form by clicking on the image below.



This enrollment form is provided as a PDF you can print or view on your screen.

Patient and Caregiver Information on MAP:

MAP has a booklet that provides information about MAP for you or your caregiver in an easy-to-read format. It has all the information you need to find out if MAP can help you.

You can print a copy of the patient and caregiver brochure by clicking on the image below.


This patient booklet is provided as a PDF you can print or view on your screen.


You will need Adobe^® Reader^® to download these files. If you don't have Adobe^® Reader^®, you can download it for free.

Adobe and Adobe Reader are registered trademarks of Adobe Systems Incorporated.

 

To listen to the full prescribing information regarding MACUGEN, please click on the link entitled "Important Safety Information" on the menu bar located on the left of the screen.