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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Valeant Pharmaceuticals |
| Program Name |
Valeant Patient Assistance Program |
| Program Address |
P.O. Box 42886
Cincinnati, OH
45242 |
| Phone Number |
800-511-2120
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| Fax Number |
513-618-0060 |
| Medications on Program |
8-MOP Capsules 10mg (methoxsalen)
Ancoban Capsules 500mg (flucytosine)
Diastat AcuDial Rectal Gel 10mg, 20mg (diazepam rectal gel)
Mestinon Syrup 60mg (pyridostigmine)
Mestinon Timespan Tablets 180mg (pyridostigmine)
Migranal Nasal Spray 4mg (dihydroergotamine nasal spray)
Oxsoralen Lotion 1oz (methoxsalen topical)
Oxsoralen-Ultra Capsules 10mg (methoxsalen)
Prostigmin Tablets 15mg (neostigmine)
Tasmar Tablets 100mg, 200mg (tolcapone)
Zelapar Orally Disingrating Tablets (selegiline)
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| Application Forms |
Valeant Patient Assistance Program
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On-line Application
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| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
Patient must not have insurance or the medication is not covered by the insurance. have an income at or below 200% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. US residency requirements are
not specified.
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| Application Process |
Anyone requesting assistance can call to request a faxed application or download it from the website. The application will be mailed out within two weeks. The completed application can be faxed or mailed back.
If the patient is approved the medication is shipped to the doctor's office. The doctor's office will be informed if the patient is denied assistance.
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| Application Requirements |
The doctor must fill out a section and sign the application. The patient must fill out a section and sign the application.
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| Program Details |
Up to a 90-day supply is sent to the doctor's office. A new application with new prescription is needed for refills. Once a year a new application with documentation is needed.
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| Last Updated |
May 05, 2010 |
