Medical Assistance Application
Thank you for your interest in the Medication Assistance Program (MAP). In order to qualify for the MAP program, you must fill out the MAP application and give us a copy of the following information:
- Proof of where you live within the 13 county metro area
- Proof of income (copy of income tax return and/or pay stubs for the last 4 pay periods).
- If you have no income, Please give us a notarized statement of support from sponsoring individual(s).
- Copy of your diabetes prescriptions from physician.
You may fax, mail, or email this information to the Diabetes Association of Atlanta. Our fax number is 404-527-7149.
Other MAP Requirements:
- You must attend a diabetes education class taught by the Diabetes Association of Atlanta within one month of being approved for the MAP program. A schedule of class dates and locations will be given to you once your application is accepted.
- You must pay a one-time $30.00 fee or $5.00 a month for 6 months once accepted into the program. The money is used to support the Medical Assistance Program.
The Diabetes Association of Atlanta will let you know if your application has been approved.
For questions about the Medication Assistance Program, please call
404-527-7150.