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

Alrex

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Valeant Patient Assistance Program for Bausch & Lomb Products

This program provides brand name medications at no or low cost

Provided by: Valeant Pharmaceuticals, Inc.

PO Box 429303
Cincinnati, OH 45242-9303

TEL: 833-862-8727


FAX: 866-777-5705
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Valeant Patient Assistance Program Application for Bausch & Lomb Products

 

Medications

  • Alrex (loteprednol etabonate)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Determined case by case
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Doctor notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 30 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Within 4-6 weeks
Refill Process Not specified
Limit One year
Re-application Not specified
   

Additional Information

Call for information on the most recent medications as the list is subject to change.


Updated December 13, 2017