Patient Services and Support

PAH Pathways^®

One point of contact for every step of your journey
Living with pulmonary arterial hypertension (PAH)^* isn't easy. That's why Actelion offers comprehensive services and support programs through PAH Pathways for patients like you, who are on Tracleer. From getting started on Tracleer to education and support, these programs are here for you every step of the way.

If you're a patient who has been prescribed Tracleer, you'll enjoy several PAH Pathways benefits. PAH Pathways provides:

• Access to Tracleer—to make sure you get your medicine quickly
• Insurance information and financial assistance—to help find the answers you need and help pay for your medicine, if eligible
• Access to Sure Steps^™—to provide education and support for your PAH^* journey
• LabTrac^™—to help your healthcare team to track your lab results

If you have any questions, call PAH Pathways toll free at 1-866-ACTELION
(1-866-228-3546) Monday‑Friday, 9 am‑8 pm (ET) / 6 am‑5 pm (PT).

Access to treatment through the
Tracleer Access Program (T.A.P. ^®)

Because of the risk of liver damage and serious birth defects associated with Tracleer, you must be enrolled in T.A.P. to receive Tracleer.

PAH Pathways administers the T.A.P program and works with your healthcare team, insurance company, and specialty pharmacy to make sure you get your medicine quickly.

To start treatment with Tracleer, you must review essential safety information with your healthcare provider, complete a Tracleer Enrollment and Renewal form, and agree to have important monthly tests. Your first step is reviewing the Tracleer Medication Guide (found in the Patient Essentials Guide) with your healthcare provider. You must then go for pretreatment liver function and, if applicable, pregnancy tests. These tests rule out that you are pregnant or that you have liver problems before starting treatment with Tracleer. This is important because of the risk of liver damage and serious birth defects associated with Tracleer.

Here's how it all comes together:

1. Your healthcare provider prescribes Tracleer and you are enrolled in the Tracleer Access Program
   
   
2. PAH Pathways contacts you
   A reimbursement counselor will:
   • Follow up with your enrollment in T.A.P.
   • Answer questions you have about insurance coverage or costs for Tracleer
   • Provide information on financial assistance programs, if needed
   
   You can call PAH Pathways with questions. It's important to call
   PAH Pathways if:
   • A reimbursement counselor leaves you a message
   • You lose your insurance or your insurance changes
   
   
3. Tracleer is delivered to you:
   • Tracleer is not available in your retail pharmacy; rather it is carried by a network of specialty pharmacies certified by Actelion to dispense Tracleer. Your specialty pharmacy ships Tracleer directly and conveniently to your home or healthcare provider's office each month you are on treatment.
   • Because of the risks associated with Tracleer, you must have liver function and pregnancy tests each month. Your specialty pharmacy will call you regularly to confirm that you have had your liver function tests and (if applicable) pregnancy tests each month before they ship your medication.
   • If you don't confirm with your specialty pharmacy that you have had your tests or if you become pregnant, your specialty pharmacy will not be able to ship Tracleer to you and will contact your healthcare provider.
   • You will receive a Medication Guide with each shipment and you should read it monthly because there may be new information.
   
   
4. Your healthcare provider renews your Tracleer enrollment every year. To continue on Tracleer, you must renew your T.A.P. enrollment each year by again reviewing the Medication Guide and completing the Tracleer Enrollment and Renewal form with your healthcare provider.

Insurance information and financial assistance

Additional help from PAH Pathways is just a phone call away. PAH Pathways Counselors can help you find the answers you need. They can help simplify and explain insurance coverage and financial assistance by:

• Verifying your insurance coverage
• Clarifying your co-payment amount before your prescription is filled
• Assisting with claims appeals and grievances
• Offering information about potential financial assistance to help you pay for medicine if you are eligible
• Assisting with Medicare/Medicaid issues, including program enrollment and drug assistance

To learn more about insurance coverage and financial assistance, call a PAH Pathways Counselor at 1‑866‑ACTELION (1-866-228-3546) or visit PAHPathways.com.

The Caring Voice Coalition (CVC) is another resource. CVC is an independent third party who offers support programs for patients with chronic illness that include financial assistance, insurance education and counseling.

Access to Sure Steps

Sure Steps is an education and support program brought to you by PAH Pathways. It's designed to answer your questions and help you make the most of your Tracleer treatment. When you become a member of Sure Steps, you gain ongoing access to patient education materials and one‑on‑one phone support from a team of Nurse Counselors to answer your questions about PAH^* and Tracleer. All at no cost to you.


Enroll in Sure Steps today!
Or simply call 1-866-ACTELION (1-866-228-3546)
Monday — Friday, 8 am - 11 pm (ET) for assistance in English or
1-877-783-7791 Monday — Friday, 9 am - 5 pm (ET) for assistance in Spanish.

LabTrac^™

Your healthcare provider may be participating in LabTrac, a program that makes it easier for your healthcare team to track your lab results, and it is available to you at no cost.

*What is Tracleer?
Tracleer is a prescription medicine indicated for patients with certain types of pulmonary arterial hypertension (PAH), which is high blood pressure in the vessels of the lungs, (WHO Group I). Tracleer can improve your ability to exercise as measured by 6-minute walk test and can slow the worsening of your physical condition and symptoms.

• In two different studies, Tracleer improved 6-minute walk distance by 35 and 76 meters. These studies focused on patients with WHO Functional Class III-IV.¹
• Clinical worsening was defined as any one of the following: a need to go to the hospital for PAH, stopping treatment because of worsening of PAH, a need for intravenous (IV) treatment (epoprostenol), or death.^2,3

Studies showing Tracleer is effective included mainly patients with NYHA Functional Class II-IV PAH. In these patients, PAH was caused by: unidentified or hereditary factors (60%); connective tissue disease (21%); being born with a hole in the heart between the left and right sides (18%).

In patients with WHO Functional Class II symptoms, Tracleer slowed the worsening of PAH, however, did not show meaningful improvement in walk distance. If you are a patient with WHO Functional Class II symptoms, your healthcare provider will consider whether the potential benefits of Tracleer outweigh the risk of liver damage, which may prevent future use of Tracleer as your disease progresses.

Tracleer is only:

• prescribed by healthcare providers who are enrolled in T.A.P.
• available to people who understand and agree to enroll in T.A.P.

It is not known if Tracleer is safe and works in children below 12 years of age.

What is the most important information I should know about Tracleer?
Tracleer is only available through the Tracleer Access Program (T.A.P.). Before you begin taking Tracleer, you must read and agree to all of the instructions in T.A.P. Because of potential liver damage and in an effort to make the chance of fetal exposure to Tracleer^® (bosentan) as small as possible, Tracleer may be prescribed only through the Tracleer Access Program (T.A.P.), by calling 1-866-228-3546. Adverse events can also be reported directly via this number.

Liver damage:

• Liver damage may not cause symptoms at first. Only a blood test can show if you have early liver damage. So you must have a blood test to check your liver function before you start Tracleer and each month after that. Your healthcare provider will order these tests. Regular blood tests are important because they will help your healthcare provider adjust or stop your treatment before there is permanent damage.
• Tracleer can cause serious liver damage, including in rare cases liver failure. The contribution of Tracleer in these cases could not be excluded. Even in situations with regular liver testing, rare cases of unexplained liver cirrhosis (scar tissue in the liver) have developed in patients with other medical conditions and taking other medications in addition to Tracleer for over 12 months. Tell your healthcare provider if you have had liver problems, including liver problems while taking other medicines. Call your healthcare provider right away if you have any of these symptoms of liver problems while taking Tracleer: nausea, vomiting, fever, unusual tiredness, stomach area (abdominal) pain, or yellowing of the skin or the whites of your eyes (jaundice).

Serious birth defects:

• Tracleer can cause serious birth defects if taken during pregnancy. You must not be pregnant when you start taking Tracleer or during Tracleer treatment. Serious birth defects from Tracleer can happen early in pregnancy. Females who are able to get pregnant must have a negative pregnancy test before starting treatment and each month during Tracleer treatment.
• Talk with your healthcare provider or gynecologist (a doctor who specializes in female reproduction) to find out about how to prevent pregnancy. Do not have unprotected sex. Tell your healthcare provider right away if you miss a menstrual period or think you may be pregnant.
• Females who are able to get pregnant must use birth control (contraception) during Tracleer treatment. You must choose and use two reliable forms of birth control at the same time, unless you have had a tubal sterilization, or have a Copper T 380A IUD or LNg-20 IUS. These methods can be used alone.
• Talk with your healthcare provider about which 2 methods of reliable birth control you should use. Your healthcare provider may recommend that you use a different method of birth control to help lower your risk of problems with your pulmonary arterial hypertension.

Who should not take Tracleer?
Do not take Tracleer if you:

• Are pregnant, plan to become pregnant, or become pregnant during Tracleer treatment. Tracleer can cause serious birth defects. All females should read the birth defects section of "What is the most important information I should know about Tracleer?"
• Have a blood test that shows possible liver injury.
• Take one of these medicines:

  —	Do not take Tracleer with cyclosporine-A, a medication used for psoriasis and rheumatoid arthritis, and to prevent rejection of heart or kidney transplants. Using cyclosporine-A with Tracleer may increase your chance of side effects.
  —	Do not take Tracleer with glyburide. Glyburide is used to treat diabetes and when used with Tracleer it may increase your chance of liver injury.

• Are allergic to any of the ingredients in Tracleer. If you have a rash, hives or your lips swell after taking Tracleer, it may be a sign of an allergy. You should stop taking your Tracleer and talk to your healthcare provider.

What are the possible side effects of Tracleer?
Tracleer can cause serious side effects, including:

• See "What is the most important information I should know about Tracleer?"
• Fluid retention and swelling of ankles and legs. Tracleer can cause your body to hold too much water, and you may get swelling of your ankles and legs. Tell your healthcare provider if you have swelling of your ankles and legs that happens either with or without weight gain, or if you have more trouble with your breathing than normal. Your healthcare provider will look for the cause of this.
• Lower sperm count. Some men who take Tracleer may have lower sperm counts. This may affect your ability to father a child. Tell your healthcare provider if fertility is a concern for you.
• Low red blood cell levels (anemia). Your healthcare provider will do blood tests to check your red blood cells during treatment with Tracleer.

The most common side effects of Tracleer are: respiratory tract infection, headache, fainting, flushing, low blood pressure, inflamed nose passages (sinusitis), joint pain and irregular heartbeats.

Tell your doctor if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of Tracleer. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA
at 1-800-FDA-1088.

Please see full Prescribing Information and Medication Guide.

Learn more about the benefits of Sure Steps and how you can enroll

REFERENCES:

1. TRACLEER^® (bosentan) full Prescribing Information. Actelion Pharmaceuticals US, Inc., February 2011.
2. Rubin LJ, Badesch DB, Barst RJ, et al. Bosentan therapy for pulmonary arterial hypertension. N Engl J Med. 2002;346(12):896-903.
3. Channick RN, Simonneau G, Sitbon O, et al. Effects of the dual endothelin receptor antagonist bosentan in patients with pulmonary hypertension: a randomised placebo-controlled study. Lancet. 2001;358:1119-1123.