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

Program 1 of 2.
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Updated April 15, 2014
Zovirax

Valeant Patient Assistance Program

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

Provided by: Valeant Pharmaceuticals, Inc.

P.O. Box 836
Somervile, NJ 08876

TEL: 866-268-7325


ALT PHONE:
FAX: 866-217-7164
Languages Spoken:

English

Program Website
 

Patient Assistance Applications

Valeant Patient Assistance Program

 

Medications

  • Zovirax  Cream dosage varies (acyclovir)
  • Zovirax  Ointment dosage varies (acyclovir)
 

Eligibility Requirements

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
   

Application

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
   

Medication

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 March 04, 2014
Zovirax

Rx Outreach Medications

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

Provided by: Rx Outreach

PO Box 66536
St Louis, MO 63166-6536

TEL: 888-796-1234


ALT PHONE: 888-RXO-1234
FAX: 800-875-6591
Languages Spoken:

English, Spanish

Program Website
 

Patient Assistance Applications

Rx Outreach Application

Rx Outreach Diabetic Supplies

Rx Outreach Medication List

Rx Outreach Refills and New Prescriptions Order Form

 

Medications

  • Zovirax  Capsule 200mg (acyclovir)
  • Zovirax  Tablet 400mg, 800mg (acyclovir)
 

Eligibility Requirements

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must reside in the US
   

Application

Obtaining Call, download or apply online
Receiving Faxed or mailed
Returning Fax or E-Prescribe online
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign
Decision Communicated Medications sent if accepted. If denied patient and Doctor notified
Decision Timeframe Usually same day
   

Medication

Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit Only limited by manufacturer's guidelines
Re-application New application yearly
   

Additional Information

Some medications are available for a fee of $20 for up to a 180 day supply.
Check the website for the exact price.

Contact Program for Spanish Application(s)/Form(s)