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

Program 1 of 2   Scroll down to see them all.  Updated June 12, 2013 Back | Print Page

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

Valeant Patient Assistance Program

Provided by:


Valeant Pharmaceuticals, Inc.
P.O. Box 836
Somervile, NJ 08876


TEL: 866-268-7325


ALT PHONE:
FAX: 866-217-7164
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Timoptic Ophthalmic Solution in Ocudose Dispenser 0.50%, 0.25% (timolol)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income Based on FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must be citizen or legal resident
Obtaining Call
Receiving Faxed or mailed
Returning Mail or fax
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign
Decision Communicated If accepted, medication sent to Dr office. If denied, Dr office is informed
Decision Timeframe Within 2-3 days
Amount/Supply Up to 90 day supply
Sent To Doctor's office
Delivery Time Within 5-7 business days
Refill Process Copy of application with new doctor signature
Limit Not specified
Re-application New application yearly

Additional Information:

Wellbutrin XL IS NOT AVAILABLE FOR NEW PATIENTS.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 2.  Updated November 05, 2012 Back | Print Page

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

Alcon Cares

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
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Timoptic Ophthalmic Solution 0.25%, 0.5% (timolol maleate)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 200% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be treated by US Doctor
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete, sign, attach proof of income
Decision Communicated Patient notified of denial in writing
Decision Timeframe Within 24-48 hours
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.



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