If you are uninsured or underinsured, you may be eligible to receive Amevive at no cost through the Astellas Access Program^SM (AAP). To apply, you and your healthcare professional will need to complete a program application and you must meet the following eligibility requirements in order to qualify for assistance:

• For uninsured patients
  If you do not have health insurance, AAP can help determine if you are eligible for the Uninsured Patient Assistance Program. To be eligible, you must be uninsured, a permanent US resident or citizen, meet financial criteria, and have been prescribed Amevive for the FDA-approved indication. This program provides Amevive free of charge if you meet certain criteria.
• For underinsured patients
  If you have insurance coverage for Amevive but cannot afford your co-payment or coinsurance, AAP can refer you to independent assistance foundations. The foundations listed below offer assistance to underinsured patients with chronic plaque psoriasis.

The HealthWell Foundation^®
PO Box 4133
Gaithersburg, MD 20878
1-800-675-8416
Fax: 1-800-282-7692
healthwellfoundation.org

National Organization for Rare Disorders, Inc. (NORD)
55 Kenosia Avenue
PO Box 1968
Danbury, CT 06813-1968
1-800-634-7207
rarediseases.org

Patient Access Network Foundation (PANF)
PO Box 221858
Charlotte, NC 28222
1-866-316-PANF (7263)
Fax: 1-866-316-7261
panfoundation.org

Want to learn more?
Call one of our reimbursement specialists at Astellas Reimbursement Services^SM or visit www.astellasreimbursement.com for more information about the Astellas Access Program.