Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Updated November 03, 2014
 

Timoptic

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Focus on Access (FOA) Program

Provided by: Bausch & Lomb Incorporated

PO Box 220662
Charlotte, NC 28222-0662

TEL: 866-272-8838


ALT PHONE:
FAX: 866-272-8839
Languages Spoken:

English

 

Patient Assistance Applications

Focus on Access (FOA) Program Enrollment Form

Focus on Access (FOA) Program Enrollment Form Instructions

 

Medications

  • Timoptic Ophthalmic Solution in Ocudose 0.25%, 0.5% (timolol maleate)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage or been denied coverage
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria Not required
US Residency Required? Yes
   

Application

Obtaining The Doctor should call for an application or download it from the website
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign and provide annual income information. Proof of income may be request by program at any time
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe 3-5 business days
   

Medication

Amount/Supply Varies
Sent To Doctor's office or specific site
Delivery Time Within 48 hours
Refill Process Doctor's office must contact the company
Limit None
Re-application Once a year new application required. Financial documentation may be requested any time
   

Additional Information