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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Valeant Pharmaceuticals |
| Program Name |
Valeant Patient Assistance Program |
| Program Address |
P.O. Box 42886
Cincinnati, OH
45242 |
| Phone Number |
800-511-2120
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| Fax Number |
513-618-0060 |
| Medications on Program |
Ancoban Capsules 500mg (flucytosine)
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| Application Forms |
Valeant Patient Assistance Program
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On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
Patient must not have insurance or the medication is not covered by the insurance. have an income at or below 200% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. US residency requirements are
not specified.
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| Application Process |
Anyone requesting assistance can call to request a faxed application or download it from the website. The application will be mailed out within two weeks. The completed application can be faxed or mailed back.
If the patient is approved the medication is shipped to the doctor's office. The doctor's office will be informed if the patient is denied assistance.
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| Application Requirements |
The doctor must fill out a section and sign the application. The patient must fill out a section and sign the application.
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| Program Details |
Up to a 90-day supply is sent to the doctor's office. A new application with new prescription is needed for refills. Once a year a new application with documentation is needed.
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| Last Updated |
September 08, 2010 |
