Allergan Botox Indigent Patient Assistance Program (PAP)

Botox Indigent Patient Assistance Program (PAP)

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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: Patientís 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):

 

 



 

 

 

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