Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

Botox Reimbursement Solutions (BRS)

For Healthcare Professionals Only

Provided by: Allergan, Inc.

PO Box 1370
San Bruno, CA 94066

TEL: Closed Program


ALT PHONE: 800-442-6869, opt. 4
FAX: 877-530-6680
Languages Spoken:

English

 

Patient Assistance Applications

 

Generic Name

 
 

Eligibility Requirements   

Insurance Status Not specified
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be residing in the US or Puerto Rico
   

Application

Obtaining Doctor/Doctor's office must call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Varies
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Doctor notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

Closed Program

Resources for HEALTHCARE PROFESSIONAL ONLY.
The Doctor must contact the program to place an order.


Updated March 12, 2018