Help Your Patients access Their Bausch Health medications

The Bausch Health Patient Assistance Program can help your eligible patients with no or limited insurance and/or qualifying financial need access their medication for free.

Download the Bausch Health PAP Application Form

How the Bausch Health Patient Assistance Program Works

In 3 simple steps, your patients can apply to receive free medication.

1 Check eligibility

Review the program eligibility criteria and list of eligible medications to confirm if your patient may qualify.

2 Submit application

Complete the application form with the patient (they may also complete it on their own). Your signature is required to verify the prescription.

3 Patient receives medication

If approved, free medication will be shipped directly to your patient’s home. No co-pays or shipping fees.

Coverage lasts up to 1 year and patients can re-apply annually.

The following information is required to complete the application.

Please take a moment to review this with your patient to ensure their application is not rejected for being incomplete. All personal information is kept secure and confidential.

Patient information

Name, date of birth, contact information
Social Security Number
Copies of Health Insurance Cards
Copies of Tax Return along with annual household income and household size
Patient's signature

Prescription Details

Your complete information, including your NPI number and contact information
Your patient's complete information
Medication name, days’ supply, dosage and refill (if any)
Your signature

You can submit the application by either:

Mail

Bausch Health
Patient Assistance Program
P.O. Box 991624
Louisville, KY 40269

or

Fax

1-844-705-0160