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

Betimol

Akorn Patient Assistance Program

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

Provided by: Akorn, Inc.


TEL: 844-202-5909


FAX: 844-500-5254
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Akorn Patient Assistance Program Application

 

Medications

  • Betimol ophthalmic solution (timolol)
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be a US resident
   

Application

Obtaining Call
Receiving Faxed or mailed
Returning Fax
Doctor's Action Complete section and sign
Applicant's Action Call to enroll
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 90 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Not specified
Refill Process Not specified
Limit Maximum of 3 refills through one year from date on original prescription
Re-application Not specified
   

Additional Information


Updated May 06, 2015