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Name of Program
RxMAP Prescription Medication Assistance Program

Physician Requests Should Be Directed To
RxMAP
P.O. Box 29043
Phoenix, AZ 85038
(800) 242-7014

Product(s) Covered By Program
Numerous products

Eligibility
Based on federal poverty level and no prescription drug coverage.

Other Program Information
All inquiries should go to RxMAP at (800) 242-7014.

Name Of Program
Patients in Need®

Physician Requests Should Be Directed To
Administrator
Searle Patients in Need® Foundation
5200 Old Orchard Road
Skokie, IL 60077
(800) 542-2526, (847) 581-6633 (fax)
or
Local Searle Sales Representative

Product(s) Covered By Program
Antihypertensives: Aldactazide® (spironolactone with hydrochlorothiazide), Aldactone® (spironolactone), Calan® SR (verapamil HCl) sustained-release, Kerlone® (betaxolol HCl)
Antihypertensive/Anti-Anginal/Antiarrhythmic: Calan® (verapamil HCl), Covera-HS™ (verapamil HCl)
Antiarrhythmics: Norpace® (disopyramide phosphate), Norpace® CR (disopyramide phosphate) extended-release
Prevention of NSAID-induced gastric ulcers: Arthrotec® (diclofenac sodium/ misoprostol), Celebrex™ (celecoxib), Cytotec® (misoprostol)

Eligibility
The physician is the sole determinant of a patient's eligibility for the program based on medical and economic need. Searle provides guidelines for physicians to consider, but they are not requirements. Searle does not review documentation for eligibility. The guidelines suggest that: patient suffers from conditions for which a Searle product in the Patients in Need® program may be appropriate; patient does not qualify for outpatient prescription drugs under private insurance, a public program, or other assistance that pays in whole or in part for prescription drugs; patient's income falls below a level suggested by Searle.

Other Program Information
Patients in Need® program certificates for free Searle medications are made available to physicians. The physician gives the patient the prescription for an appropriate Searle medication along with a certificate for the Patients in Need® program. The patient then takes the prescription and the certificate to the pharmacy of his/her choosing, and the pharmacist dispenses the prescription to the patient free of charge. The pharmacist submits the certificate to Searle and is reimbursed by Searle.

Physician Requests Should Be Directed To
Procter & Gamble Pharmaceuticals
c/o Express Scripts
P.O. Box 6553
St. Louis, MO 63166-6553
(800) 830-9049

Product(s) Covered By Program
Actonel, Asacol, Dantrium Capsules, Didronel, Macrodantin, Macrobid

Eligibility
Procter & Gamble Pharmaceuticals has always tried to ensure that all patients have full access to its products. To qualify, patients should have exhausted prescription coverage through private or public insurance. Each patient's case is handled on an individual basis.

The company relies on the physician's assessment of need to determine eligibility. Application forms are provided by the company for the physician/patient to complete.

An original prescription duly signed by the attending physician for one of the company's products is required.

Other Program Information
The quantity of product supplied depends on diagnosis and need, but generally a three-month supply is provided for a chronic medication. Refills require a new prescription and application form from the physician. The prescription medication is sent directly to the physician, who provides it to the patient. Applications are good for one year. Afterwards, patients must be re-screened to ensure continued eligibility.

Please see listing for Aventis Pharmaceuticals.

Name of Program
Roche Medical Needs Program

Physician Requests Should Be Directed To
Roche Medical Needs Program
Roche Laboratories, Inc.
340 Kingsland Street
Nutley, NJ 07110
(800) 285-4484

Product(s) Covered By Program
Roche product line with some exceptions

Eligibility
The Roche Medical Needs Program is designed as an interim solution for patients who lack third-party outpatient prescription drug coverage under private insurance, government-funded programs (Medicaid, Medicare, Veterans Affairs, etc.), or private/community sources and are unable to afford to purchase our products on their own.

Roche offers the Medical Needs Program as a philanthropic endeavor to assure access to Roche products for needy patients at no charge until alternative funding can be found. The Roche Medical Needs Program is part of Roche's commitment to assure access to our products and is not intended to supplant or replace prescription drug coverage provided by third-party public or private payers.

This program is for individual outpatients who meet the Medical Needs Program criteria and is offered through licensed practitioners. The program is not intended for clinics, hospitals, and/or other institutions.

Other Program Information
Roche Medical Needs Program forms obtained from the Medical Needs Department are required. Applications are provided only to licensed practitioners. Physicians' and patients' signatures and a DEA number are required on the application. A new application form must be completed for patients requiring refills. All completed applications will be reviewed and approved by Roche on a case-by-case basis using the established criteria of the program. Patients and providers may be requested to participate in reimbursement case management based on the product requested. Up to a three-month supply of product will be shipped directly to the licensed practitioner within two to three weeks.

Name of Program
Roche Medical Needs Program for CellCept^® (mycophenolate mofetil), CYTOVENE^® (ganciclovir capsules), and CYTOVENE^®-IV (ganciclovir sodium for injection)

Physician Requests Should Be Directed To
Roche Transplant Reimbursement Hotline
(800) 772-5790

Product(s) Covered By Program
CellCept^® (mycophenolate mofetil), CYTOVENE^® (ganciclovir capsules), and CYTOVENE^®-IV (ganciclovir sodium for injection). CYTOVENE products for use with transplant patients.

Name of Program
Roche Medical Needs Program for FORTOVASE— (saquinavir), INVIRASE^® (saquinavir mesylate), CYTOVENE^® (ganciclovir capsules), CYTOVENE^®-IV (ganciclovir sodium for injection), and HIVID^® (zalcitabine)

Physician Requests Should Be Directed To
Roche HIV Therapy Assistance Program
(800) 282-7780

Product(s) Covered By Program
FORTOVASE— (saquinavir), INVIRASE^® (saquinavir mesylate), CYTOVENE^®(ganciclovir capsules), CYTOVENE^®-IV (ganciclovir sodium for injection), and HIVID^® (zalcitabine). CYTOVENE products for use with HIV/AIDS patients

Name of Program
Roche Medical Needs Program for Kytril (granisetron), Roferon®-A (Interferon alpha-2a, recombinant), Vesanoid® (tretinoin), Xeloda (capecitabine), and Fluorouracil Injection

Physician Requests Should Be Directed To
Oncoline™/Hepline™ Reimbursement Hotline
(800) 443-6676 (press 2 or 3)

Product(s) Covered By Program
Roferon®-A (Interferon alpha-2a, recombinant), Kytril (granisetron), Vesanoid® (tretinoin), Xeloda (capecitabine), and Fluorouracil Injection

Name Of Program
Patient Assistance Program

Physician Requests Should Be Directed To
Boehringer Ingelheim Pharmaceuticals, Inc.
c/o ESI/SDS
P.O. Box 66555
St. Louis, MO 63166-6773
(800) 556-8317 (for information and form)

Product(s) Covered By Program
Oramorph SR® (morphine sulfate sustained release) Tablets; Roxanol™ (morphine sulfate concentrated oral solution); Roxanol 100™ (morphine sulfate concentrated oral solution) and Roxicodone (oxycodone) Tablets for FDA-approved indications only.

Eligibility
Eligibility to be determined solely by Boehringer Ingelheim Pharmaceuticals, Inc. and Roxane Laboratories. Patient must be a U.S. citizen ineligible for prescription assistance through Medicaid or private insurance. Patient must meet established financial criteria.

Other Program Information
All requests are reviewed and approved on a case-by-case basis. Application form, prescription, and patient's income documentation are required. Maximum of three months supply may be provided per request. Complete financial re-application is required annually. Renewal requests within the same year require only the application form and a prescription.

Program is subject to change without notice. Current program specifics can be obtained by calling the toll-free number above.

Please see listing for Novartis Pharmaceuticals.

Name Of Program Sankyo Pharma Open Care Program

Physician Requests Should Be Directed To
Sankyo Pharma Open Care Program
P.O. Box 8409
Somerville, NJ 08876
(866) 268-7327

Product(s) Covered By Program
WelChol™ (colesevelam HCI)

Eligibility
The Sankyo Pharma Open Care Program is available to qualified patients with demonstrated medical and financial need. The program assists patients who are prescribed Sankyo products and are uncertain of their insurance coverage, in locating alternative payment sources. Free product is provided to uninsured patients who qualify and for whom no alternative source of reimbursement can be identified. Patients must reside in the United States and have a U.S. treating physician.

Other Program Information
The physician's office must apply on behalf of a patient. Applications are available from Sankyo Pharma representatives or from Sankyo Pharma Open Care Program hotline at (866) 268-7327. Upon receipt and approval of a completed application, all patients will receive a supply (the amount depends on the product) of medication, which will be shipped to the physician's office on the patient's behalf. Patients who remain on therapy will complete reimbursement counseling to identify alternative sources of insurance. Patients without alternative sources of insurance will continue to receive free product. Periodic reviews of applications will be conducted to ensure continued eligibility.

Name Of Program
Needy Patient Program

Physician Requests Should Be Directed To
Sanofi — Synthelabo Inc.
Needy Patient Program
c/o Product Information Department
90 Park Avenue
New York, NY 10016
(800) 446-6267

Product(s) Covered By Program
Aralen,® Danocrine,® Drisdol®, Hytakerol,® Mytelase,® NegGram,® pHisoHex,® Plaquenil,® Primaquine.® Hyalgan,® Primacor,® and Skelid® eligibility determined on a financial case-by-case basis.

Other Program Information
The physician's office should contact the Sanofi-Synthelabo Product Information Department to apply on behalf of a patient. An application is sent to the physician's office for completion and signature, in addition to a signed prescription. Upon receipt of completed application and prescription from physician, and upon approval of application, medication will be shipped directly to the physician's office from the distribution center. Each physician is allowed to enroll six patients per year. Each patient can receive a 3-month supply of medication, with an option of one refill for an additional three months supply for a total of six months medication for one year. The physician must contact Sanofi-Synthelabo's office for the refill.

Name Of Program
Commitment to Care

Physician Requests Should Be Directed To
For Intron A/Eulexin:
(800) 521-7157

For Other Products:
Schering Laboratories/Key Pharmaceuticals
Patient Assistance Program
P.O. Box 52122
Phoenix, AZ 85072
(800) 656-9485

Product(s) Covered By Program
Most Schering/Key prescription drugs

Eligibility
The program is designed to assist those patients who are truly in need — indigent — who are not eligible for private or public insurance reimbursement and who cannot afford treatment. Patient eligibility is determined on a case-by-case basis based upon economic and insurance criteria. Eligibility criteria are currently being reevaluated and may be subject to change.

Other Program Information
Physician and patient complete an application form. Application is reviewed on a case-by-case basis. Repeat requests require a new application form to be completed.

Please see listing for Pharmacia Corporation.

Name Of Program
Connections for Growth

Physician Requests Should Be Directed To
Serono Connections for Growth
(800) 582-7989

Product(s) Covered By Program
Saizen® (somatropin [rDNA origin] for injection) for treatment of pediatric growth hormone deficiency

Name Of Program
SeroCare^SM

Physician Requests Should Be Directed To
SeroCare^SM
100 Longwater Circle
Norwell, MA 02061
(800) 714-2437, (800) 214-8698 (fax)

Product(s) Covered By Program
Serostim™ (human growth hormone [rDNA origin]) for treatment of AIDS wasting

Name Of Program
NORD/Sigma-Tau Carnitor^® Drug Assistance (CDA) Program

Physician Requests Should Be Directed To
Carnitor^® Drug Assistance Program
c/o NORD
P.O. Box 8923
New Fairfield, CT 06812-8923
(800) 999-NORD

Product(s) Covered By Program
Carnitor^® (levocarnitine)

Eligibility
All applicants must be citizens or permanent residents of the United States. Eligibility is determined by medical and financial criteria and applied to a cost-share formula. A patient applying for eligibility under the CDA Program must first demonstrate having a legal prescription for Carnitor^®. Second, the applicant must prove financial need above and beyond the availability of federal and state funds, private insurance or family resources.

If an applicant is a minor or an adult dependent, NORD may request financial information of family members or guardians before determining the applicant's eligibility.

Applications must be submitted annually to determine continued medical and financial eligibility. Acceptance into the program at any time does not guarantee ongoing eligibility, nor does it mean that applicants are entitled to or will be granted benefits at a later time.

Other Program Information
Generally, a patient over 18 years of age may submit his or her own application. If the patient is an adult under the guardianship of another adult, or is a minor, the patient and his/her guardian or parents must jointly submit an application. Applications are reviewed throughout the year. One application per patient, per year, will be accepted. In the event of a significant change in a patient's circumstances, a second application may be considered.

Name Of Program
NORD/Sigma-Tau Matulane^® Patient Assistance Program

Physician Requests Should Be Directed To
Matulane^® Patient Assistance Program
c/o NORD
P.O. Box 8923
New Fairfield, CT 06812-8923
(800) 999-NORD

Product(s) Covered By Program
Matulane^® (procarbazine hydrochloride)

Eligibility
All applicants must be medically eligible for Matulane by having a diagnosis of Stage III or IV Hodgkin's disease documented by the treating physician, or any other lymphomas where a physician feels a response is possible. All applicants must be a U.S. citizen or a permanent U.S. resident. All applicants must sign waivers and release of liability forms. The patient is responsible for shipping and handling costs incurred. Applicants must prove financial need above and beyond the availability of federal and state funds, private insurance or family resources.

Other Program Information
One application will cover the duration of the therapy regimen that is prescribed by the treating physician. This therapy is used in conjunction with certain other anticancer drugs for the treatment of Stage III and IV Hodgkin's disease.

Please see listing for GlaxoSmithKline.

Name Of Program
Patient Assistance Program

Physician Requests Should Be Directed To
Solvay Pharmaceuticals, Inc./
Unimed Pharmaceuticals, Inc.
Patient Assistance Program
c/o Express Scripts Specialty Distribution Services
P.O. Box 66550
St. Louis, MO 63166-6550
(800) 256-8918

Product(s) Covered By Program
Solvay Pharmaceuticals, Inc:
ACEON® (perindopril erbumine) Tablets 2 mg, 4 mg and 8 mg; CREON® MINIMICROSPHERES (pancrelipase) Delayed-Release Capsules 5, 10 and 20; ESTRATAB® (esterified estrogens tablets, USP) 0.625 mg; ESTRATEST® (esterified estrogens, USP 1.25 mg and methyltestosterone, 2.5 mg) Tablets; ESTRATEST® H.S. (esterified estrogens USP 0.625 mg and methyltestosterone, 1.25 mg) Tablets; LITHOBID® (lithium carbonate, USP) Tablets 300 mg; ROWASA® Rectal Suspension Enema (mesalamine) 4g/60mL unit dose.

Unimed Pharmaceuticals, Inc:
ANADROL® (oxymetholone) Tablets 50 mg; AndroGel® 1% (testosterone gel) CIII; MARINOL® (dronabinol) Capsules; TEVETEN® (eprosartan mesylate) Tablets 400 mg and 600 mg

Eligibility
The patient must be a legal U.S. resident. The patient must not have medical insurance. The patient must be medically indigent (unable to afford medication). This is determined by comparing the patient's annual household income minus out-of-pocket medical expenses to poverty guidelines established by the federal government.

Other Program Information
Physicians apply on behalf of the patient by submitting a written request on an application form. Blank forms may be obtained by calling (800) 256-8918. Ongoing patient participation is available based on continued medical and financial need.

Name Of Program
Indigent Patient Pharmaceutical Program

Physician Requests Should Be Directed To
Medical Services Department
275-2E-13, 3M Center
St. Paul, MN 55144-1000
(800) 328-0255, (651) 733-6068 (fax)

Product(s) Covered By Program
Most drug products sold by 3M Pharmaceuticals in the United States

Eligibility
Patients whose financial and insurance circumstances prevent them from obtaining 3M Pharmaceuticals drug products considered to be necessary by their physicians. Consideration is on a case-by-case basis.

Name of Program:
Patient Assistance Program

Physician Requests Should Be Directed To:
Takeda Pharmaceuticals America, Inc. (TPA)
Patient Assistance Program
877-TAKEDA or (877) 825-3327

Product(s) Covered By Program:
ACTOS (pioglitazone hydrochloride)

Eligibility:
Enrollment for the Patient Assistance Program of TPA is valid for one year. The following criteria must be met for the patient to be considered: (A) The patient's annual income may not be more than three time the current US Department of Human Services Poverty Guideline. (B) The patient has no insurance coverage for prescriptions. (C) The patient is ineligible for government (e.g. Medicaid) or private programs that cover the cost of prescription drugs. (D) The patient is a legal citizen of the US. (E) A signature of both the patient and physician is required on the mailer. (F) A completed prescription must be included with the mailer. Patients will be notified that the year is up thirty days before the end of the program at which time they will have to be re-enrolled into the program by a physician.

Other Program Information:
To enroll qualified patients in the Takeda Patient Assistance Program, phone (877) 825-3327. An enrollment form will then be faxed to the patient's physician. Once the form has been signed by the physician and the patient, the form and a 90-day prescription for ACTOS (15, 30, or 45 mg) should be faxed to Specialty Distribution Services (SDS) at (800) 497-0928. Once the patient is approved for the program, SDS will send the patient a welcome letter with the prescription of ACTOS along with a refill mailer form for future shipments. The physician will also receive a fax regarding the patient's acceptance into the program.

Please see listing for Solvay Pharmaceuticals, Inc..

Name Of Program
Norplant Foundation

Physician Requests Should Be Directed To
The Norplant Foundation
P.O. Box 25223
Alexandria, VA 22314
(703) 706-5933

Product(s) Covered By Program
The Norplant^® (levonorgestrel implants) five-year contraceptive system

Eligibility
Determined on a case-by-case basis and limited to individuals who cannot afford the product and who are ineligible for coverage under private and public sector programs.

Name Of Program
Rheumatoid Arthritis Assistance Foundation

Physician Requests Should Be Directed To
Rheumatoid Arthritis Assistance Foundation
P.O. Box 766
Washington, DC 20077-1207
(800) 282-7704, (888) 508-8083 (fax)

Product(s) Covered By Program
ENBREL^® (etanercept)

Eligibility
To qualify for assistance, patients or providers should contact 1-800-282-7704 and staff will screen patients for eligibility over the phone. If the patient appears to qualify, an application will be mailed directly to the patient. Eligibility criteria are subject to change without notice.

Other Product Information
The Rheumatoid Arthritis Assistance Foundation was established to improve access to ENBREL^® for patients who have limited resources. To be eligible for assistance, patients must meet the criteria set by the Foundation Board of Directors. Please call 1-800-282-7704 for more information or to discuss eligibility.

Name Of Program
Wyeth-Ayerst Laboratories Patient Assistance Program

Physician Requests Should Be Directed To
John E. James
Professional Services IPP
31 Morehall Road
Frazer, PA 19355

Product(s) Covered By Program
Various products (not including schedule II, III, or IV products)

Eligibility
Limited to individuals, on a case-by-case basis, who have been identified by their physicians as "indigent," meaning:

1. Low or no income
2. Not covered by any third-party agency

Other Product Information
The program is accessed by physicians whose patients meet the eligibility requirements. A three-month supply of specific products is provided directly to the physician for dispensing to the patient. The patient's signature is required on the application form.

Please see listing for AstraZeneca.