Follow these simple steps to apply:

  • Find out if you are eligible.
    • Check here to see if you may be eligible to apply for the Bausch Health Patient Assistance Program. If you’ve already done so, go on to step 2
  • Get the application.
    • Complete the application online or print it and complete it by hand. You can call us at 833-862-8727, 8 AM to 5 PM ET to have one mailed or emailed to you
  • Complete the application.
    • To begin, read and follow all the instructions on the cover page
    • Complete the Patient Information and Insurance Information Sections on page 1
    • Print all pages of the application
    • Read and sign the Patient Authorization and Certification on page 2
    • Attach a copy of your medical or prescription insurance cards
  • Bring the application to your prescriber.
    • Have your prescriber complete pages 4 through 6 and ensure they sign the Prescription on Page 5 and Prescriber Certification on Page 6
  • Submit the application.
    • Include the completed application form, documentation (if requested)
    • By mail

      Bausch Health Patient Assistance Program

      P.O. BOX 6122

      Lawrenceville, NJ 08648

      By fax

      866-777-5705

Next Steps

Review

We will review and confirm the information in your application and provide a response.

Approvals

If approved, you are eligible to receive your Bausch Health prescription product(s) at no cost to you for up to one year.*

There is no maximum benefit limit. You may be able to reapply to the program annually if you continue to meet eligibility requirements and have a valid prescription.

*Patients with Medicare Part B or Medicare Part D who are found eligible will be approved through December 31.

Refer to FAQs?

If you have questions about your eligibility or would like to speak with us about alternate funding options, please call the Bausch Health Patient Assistance Program at 833-862-8727, 8 AM to 5 PM ET.