Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Updated October 28, 2014
 

Ciloxan

Alcon Cares

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

Provided by: ALCON Cares, Inc.

Alcon Cares, Inc.
TB3-4
6201 South Freeway
Fort Worth, TX 76134-0450

TEL: 800-222-8103


ALT PHONE:
FAX: 800-554-2660
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Alcon Cares Application

 

Medications

  • Ciloxan Ophthalmic Ointment 3% (ciprofloxacin)
  • Ciloxan Ophthalmic Solution 3% (ciprofloxacin)
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Considered on exception basis
Income At or below 200% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be treated by US Doctor
   

Application

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

Medication

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.

Contact program for Spanish application.