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

Bausch and Lomb Indigent Patient Program

This program provides brand name medications at no or low cost

Provided by: Bausch & Lomb Incorporated

PO Box 1013
Somerville, NJ 08876

TEL: Closed Program

ALT PHONE: 866-516-0744
FAX: 866-856-2235
Languages Spoken:

English, Spanish


Patient Assistance Applications


Generic Name


Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? No
Income At or below 200% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must be a US resident


Obtaining Doctor/Doctor's office must call
Receiving Faxed
Returning Fax or mail
Doctor's Action Complete section, sign, attach prescription and include copy of DEA or state license number
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Doctor notified
Decision Timeframe Not specified


Amount/Supply Up to 30 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Within 4-6 weeks
Refill Process New application and new prescription
Limit Not specified
Re-application New application needed for each fill

Additional Information

Closed Program

Updated December 29, 2017