Botox Patient Assistance Program - Patient Assistance Programs

Summary

Allergan, Inc. was founded in Irvine, California, 1948. They are a worldwide provider of pharmaceutical and medical device products revolving around the ophthalmic, neurological, medical aesthetics, medical dermatological, breast aesthetics, and obesity intervention markets. Allergan, Inc. produces both prescription and non-prescription products for treatment of: glaucoma, ocular inflammation, bacterial conjunctivitis, infection allergy, dry eye disease, acne, wrinkles, psoriasis, rosacea, and neuromuscular disorders.

Botox is a nerutoxin launched by Allergan, Inc. in 2004. Botox has been approved by the FDA for treatment of cervical dystonia, strabismus, and blepharospasm. Botox is administered as an injection.

Eligibility

Botox Patient Assistance Program, a patient assistance program provided by Allergan, Inc., offers Botox at no cost for up to 1 year to those who are eligible for the program. Eligibility is based off of the following requirements:

You must be a citizen of the United States or its Territories.

You must be uninsured or underinsured.

You must have a diagnoses that requires Botox treatment.

Your income must be less than or equal to 300% of the Federal Poverty Guideline for the size of your household (see chart below).

SOURCE: 2008 Poverty Chart

Family Size

300%

250%

200%

150%

133%

100%

$32,490

$27,075

$21,660

$16,245

$14,404

$10,830

$43,710

$36,425

$29,140

$21,855

$19,378

$14,570

$54,930

$45,775

$36,620

$27,465

$24,352

$18,310

$66,150

$55,125

$44,100

$33,075

$29,327

$22,050

$77,370

$64,475

$51,580

$38,685

$34,301

$25,790

$88,590

$73,825

$59,060

$44,295

$39,275

$29,530

$99,810

$83,175

$66,540

$49,905

$44,249

$33,270

$111,030

$92,525

$74,020

$55,515

$49,223

$37,010

Each Additional Family Member

$11,220

$9,350

$7,480

$5,610

$4,974

$3,740

What´s Next?

Fill out the program enrollment form located to your right. If you don't see an enrollment form available please call Allergan, Inc. program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.

Other Tips

If you have any questions please call the Allergan, Inc. program directly.
Fill out as much of the information on the enrollment form as possible. The more information you have pre-filled the easier the progrm is to enroll in.
Write down the refill dates for your program and set a reminder here on PatientAssistance.com so that you don't run out of medication.
Do not write messy on your forms as this will delay any response.
Call and write thank you notes to AAI Pharma Inc. program. Without their help millions of people will be without medication.