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

Valeant Patient Assistance Program for Salix Pharmaceuticals Products

This program provides brand name medications at no or low cost

Provided by: Valeant Pharmaceuticals, Inc.

PO Box 429303
Cincinnati, OH 45242-9303

TEL: 833-862-8727


FAX: 866-777-5705
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Valeant Patient Assistance Program Application for Salix Pharmaceuticals Products

 

Brand Name Medications Covered

 
  • Apriso capsule; extended release
  • Relistor
  • Cycloset
  • Uceris
  • MoviPrep oral solution
  • Xifaxan
 

Generic Name

 
  • bromocriptine
  • methylnaltrexone bromide
  • budesonide
  • rifaximin
  • mesalamine capsule; extended release
  • sodium sulfate/ascorbic acid oral solution
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? Determined case by case
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be a US resident and treated by a US licensed healthcare provider
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Refill/reorder form included with shipment
Limit Not specified
Re-application New application yearly
   

Additional Information

Hardship appeals for patients residing in Puerto Rico will be reviewed on a case-by-case basis.

Call for information on the most recent medications as the list is subject to change.


Updated December 13, 2017