Allergan
Botox Indigent Patient Assistance Program (PAP)
Sponsor Organization
Allergan
Prescription Medication Assistance Organization Contact
c/o NORD
PO Box 8923
New Fairfield, CT 06812
Phone: (800) 530-6680
Medications sent to: Patient’s Doctor
Prescription Medications/Products Covered:
BOTOX
Program Eligibility Requirements:
The objective of the Patient Assistance Program (PAP) is to provide assistance to those patients who are without another form of drug coverage and cannot afford their medications. Patients must reside in the United States and be under the care of a U.S.-based physician and not be eligible for drug coverage by any private or public assistance program such as Medicare or Medicaid. Patients will be evaluated on a case-by-case basis; however, the following criteria required for consideration in the Botox Patient Assistance Program (PAP):
- Medically appropriate, accepted use of Botox
- Annual gross income limits
- Submission of income documentation (most recent tax return, W-2 form, or pay stub)
- U.S. citizen or legal resident
- Uninsured for Botox
Additional Information and/or Requirements (known):
