Streamline Your Prescription Process with MAP Fax Rx
For efficient, transparent communication and easy tracking, send your prescription through MAP Fax Rx. Your fax will appear in the Message Center under “Rx Faxes”, and once received by the pharmacy, it will be listed under “Referral/Rx Received”. Get Started.
Alternatively, if you are unable to send an electronic referral, you can download the PDFs below and send to us via fax.
Required forms for Tracleer® (bosentan):
This medication has REMS requirements. REMS, or Risk Evaluation and Mitigation Strategy, requirements are put in place to ensure the safe use of certain medications with known risks. The requirements aim to minimize the potential risks while allowing patients to access prescribed medications. For more information about the REMS requirements for patient and prescriber enrollment and to access the enrollment forms, please visit the REMS program website.
Please complete the following and fax to the number indicated on the form.
Getting your patient started on PAH therapy
Pulmonary arterial hypertension (PAH) is characterized as WHO Group 1. The diagnosis of PAH may require confirmation with a complete right heart catherization. The current hemodynamic definition of PAH is a mean pulmonary artery pressure greater than 25mmHg; a pulmonary capillary wedge pressure, or left ventricular end-diastolic pressure less than or equal to 15mmHg; and a pulmonary vascular resistance greater than 3 Wood units.