Contact info
- Phone
- 1-833-862-8727
- Fax
- 1-844-705-0160
- Mailing address
- PO Box 991624Louisville, KY 40269
Eligibility
- Patient must be a legal United States resident.
- Must have a valid prescription from a licensed U.S. healthcare professional for a product made available through the Bausch Health PAP.
- Patient must not have insurance coverage for the prescribed Bausch Health product.
- Eligibility for patients with Medicare Part D are determined on case-by-case basis.
- Meet the pre-defined eligibility requirements and total annual household income requirements.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Dependents
- Income limit goes up for each dependent
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Yes
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Proof of income
- Prescriber license number
- NPI number
- Both DEA and state license numbers
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider or patient
- Supply per shipment
- Varies
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- New application every 12 months
Medications covered
- Aplenzin (bupropion hydrobromide)
- Arazlo (tazarotene)
- Bryhali lotion (halobetasol propionate)
- Cabtreo (clindamycin phosphate, adapalene and benzoyl peroxide)
- Cuprimine capsules (penicillamine)
- Diazepam Rectal Gel (Diazepam Rectal Gel)
- Duobrii (halobetasol propionate and tazarotene)
- Jublia (efinaconazole)
- Luzu Cream (luliconazole)
- Noritate Cream (metronidazole)