| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Bausch Health Patient Assistance ProgramThis program provides brand name medications at no or low cost |
|||
Provided by: Bausch Health Companies, Inc. |
|||
PO Box 6122 TEL: 833-862-8727FAX: 844-705-0160 |
Languages Spoken:
English |
||
Program Applications and Forms |
|||
Bausch Health Patient Assistance Program Application |
|||
Medications |
|||
|
|||
Eligibility Requirements |
|||
| Insurance Status | Must have no prescription coverage for needed medication | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Based on FPL | ||
| Diagnosis/Medical Criteria | FDA-approved diagnosis | ||
| US Residency Required? | Must be a US resident and treated by a US licensed healthcare provider | ||
Application |
|||
| Obtaining | Call | ||
| Receiving | Faxed | ||
| Returning | Fax or mail | ||
| Doctor's Action | Complete section, sign, attach required documents | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Not specified | ||
Medication |
|||
| Amount/Supply | Varies | ||
| Sent To | Doctor's office or patient's home | ||
| Delivery Time | Not specified | ||
| Refill Process | Not specified | ||
| Limit | One year | ||
| 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 May 11, 2022 | |||
