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Patient Assistance Information

 
1 Program for Macugen Injection
 
 
Macugen Access Program

PO Box 220662
Charlotte, NC 28222-0662
Phone : 866-272-8838
Fax: 866-272-8839
Eligibility
> The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. The patient must also be a US resident.
Who Can Apply
> Anyone requesting assistance can call to request a faxed application or download it from the website.
Required
> The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and provide annual income information. Financial documentation (proof of income) can be requested at any time by the program.
Supply
> One injection
Ship To
> Doctor's office
Note
> Once a year a new application is needed. Financial documentation (proof of income) can be requested at any time by the program.
 
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.
 
Macugen Injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader