Patient Assistance Program


(levonorgestrel-releasing intrauterine system)
Eligibility for the Allergan Pharma, Inc. program is based upon information you and your licensed practitioner provide on the application form. If you are approved, you will receive a three-month supply of the product you require at no charge. Your medication will be shipped to your licensed practitioner's office for them to dispense to you.
Download Application Form Frequently Asked Questions
For more information related to the products above, please contact us at:

Phone: +1 844 4AGN PAP (+1 844 424 6727)
Fax: +1 844 708 0036