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

Travatan Z

Novartis Patient Assistance Foundation, Inc.

This program provides medication at no cost.

Provided by: Novartis Pharmaceuticals Corporation

PO Box 52029
Phoenix, AZ 85072-2029

TEL: 800-277-2254


FAX: 855-817-2711
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Novartis Patient Assistance Foundation, Inc. Enrollment Application: Contact program

Novartis Patient Assistance Foundation, Inc. Enrollment Application (Spanish): Contact program

 

Medications

  • Travatan Z ophthalmic solution/drops (travoprost)
 

Eligibility Requirements   

Insurance Status Contact program for details.
Those with Part D Eligible? Contact program for details.
Income At or below 600% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US, Puerto Rico or the USVI
   

Application

Obtaining Call or download
Receiving Faxed
Returning Fax or mail
Doctor's Action Complete section, sign, attach prescription for 90 days
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Doctor notified via mailed letter
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Patient's home, unless otherwise noted
Delivery Time Not specified
Refill Process Patient must contact company
Limit Not specified
Re-application New application, new documentation yearly
   

Additional Information

For Focalin XR, Clozaril, and Ritalin LA, Clozarila pharmacy card will be issued. All other medication will be shipped directly to the patient, unless otherwise noted.

*Additional products may be available. Please contact the program for a complete product listing. www.pap.novartis.com
Updated March 20, 2020