NeedyMeds

This program provides both brand name and generic medications at no or low cost.

Alcon Cares

Provided by:

ALCON

Alcon Cares, Inc. TB3-4 6201 South Freeway Fort Worth, TX 76134-0450 TEL: 800-222-8103 ALT PHONE: FAX: 800-554-2660	Program Website

	Languages Spoken: English

Patient assistance
applications

Alcon Cares

Medications

Acular LS Ophthalmic Solution 0.4% (ketorolac tromethamine)

Eligibility Requirements

APPLICATION

MEDICATION

Insurance Status	May have insurance
Those with Part D Eligible?	Yes
Income	At or below 200% of FPL
Diagnosis/Medical Criteria	Not specified
US Residency Required?	Must be treated by US Doctor

Obtaining	Call or download
Receiving	Faxed, mailed or downloaded from website
Returning	Mail or fax
Doctor's Action	Complete section, sign
Applicant's Action	Complete, sign, attach proof of income
Decision Communicated	Patient notified of denial in writing
Decision Timeframe	Within 24-48 hours

Amount/Supply	Up to 6 months supply
Sent To	Doctor's office
Delivery Time	Within 3 weeks of receiving application
Refill Process	Copy of application with new dates
Limit	Not specified
Re-application	New application yearly

Additional Information:

Those over the 250% FPL guidelines may have their medical expenses taken into consideration. OTC products may be sent to either the patient's home or the doctor's office.

Some medications are available only as generic and some are available only as brand name. CONTACT THE PROGRAM FOR DETAILS.