Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Updated January 12, 2015

Alphagan P

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Allergan Patient Assistance Program

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

Provided by: Allergan, Inc.

PO Box 42847
Cincinnati, OH 45242

TEL: 800-553-6783

FAX: 513-618-0054
Languages Spoken:


Program Website


Patient Assistance Applications

Allergan Patient Assistance Program Application



  • Alphagan P Ophthalmic Solution 0.1% (brimonidine tartrate)

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? No
Income At or below 200% of FPL, adjusted for household size
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes


Obtaining Call
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Doctor notified of denial
Decision Timeframe 2-4 business days


Amount/Supply Up to 6 months supply
Sent To Doctor's office
Delivery Time Not specified
Refill Process Copy of application with new doctor signature
Limit Not specified
Re-application New application every 12 months

Additional Information

Proof of income is needed annually