Patient Assistance Programs

U.S. Patient Assistance Programs

The Allergan Patient Assistance Programs provide certain products to patients in the United States who are unable to afford the cost of their medication and who meet other eligibility requirements.
More information about each program is detailed below.

Allergan Patient Assistance Program:


  • Armour ® Thyroid (thyroid tablets, USP) Tablets
  • AVYCAZ ® (ceftazidime and avibactam) Injection
  • Bystolic ® (nebivolol) Tablets
  • Canasa ® (Mesalamine, USP)
  • Crinone ® (progesterone gel)
  • Dalvance ® (dalbavancin) Vials
  • Delzicol ® (mesalamine) Oral Capsules
  • Estrace ® (estradiol) Cream
  • Fetzima ®  (levomilnacipran) Extended Release Capsules & Titration Pack
  • Gelnique ® (oxybutynin chloride 10 % gel)
  • Infed ® (Iron Dextran) Injection
  • Liletta ® (levonorgestrel) Intrauterine Contraceptive Device
  • Linzess ® (linaclotide) Capsules
  • Monurol ® (fosfomycin) Powder
  • Namenda ® (memantine HCl) Tablets
  • Namenda ® (memantine HCl) Oral Solution
  • Namenda XR ® (memantine HCl) Extended Release Capsules & Titration Pack
  • Namzaric ® (memantine hydrochloride extended - release and donepezil hydrochloride) Capsules
  • Pylera ® (bismuth subcitrate potassium, metronidazole, and tetracycline hydrochloride) Capsules
  • Rapaflo ® (silodosin) Capsules
  • Rectiv ® (nitroglycerin) Ointment
  • Saphris ® (asenapine maleate) sublingual tablet
  • Savella ® (milnacipran HCl) Tablets & Titration Pack
  • Teflaro ® (ceftaroline fosomil) for injection
  • Trelstar ® (triptorelin pamoate) injectable suspension
  • Viberzi ® (eluxadoline) Tablets
  • Viibryd ® (vilazodone HCl) Tablets & Titration Pack
  • Viokace ® (Pancrelipase) Tablets
  • Vraylar ™ (cariprazine)
  • Zenpep ® (Pancrelipase) Capsules


  • AeroChamber Plus ® Flow-Vu ® Mouthpiece*/ Flow-Vu ® Mask* - (*Maximum amount is one per applicant in six month period)

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.

For more information related to the products above, please contact us at:

Phone: +1 800 851 0758
Fax: +1 844 708 0036

Allergan Patient Assistance Programs:

Eye and Dermatology Medications

  • Aczone® (dapsone 5%) Gel
  • Acuvail® (ketorolac tromethamine 0.45%) ophthalmic solution
  • Alphagan® P (brimondidine tartrate 0.1%)  ophthalmic solution
  • Combigan®(brimondidine tartrate/timolol maleate 0.2%/00.5%) ophthalmic solution
  • Lumigan® (bimatoprost 0.01%) ophthalmic solution
  • Pred Forte® (prednisolone acetate 1.0%) ophthalmic suspension
  • Restasis® (cyclosporine ophthalmic emulsion)
  • Tazorac® (tazarotene 0.05%) Cream;  Tazorac® (tazarotene 0.1%) Cream
  • Tazorac® (tazarotene 0.05%) Gel ;  Tazorac® (tazarotene 0.05%) Gel
For more information, please visit rxhope.com.

Eye-Retina Medication

  • Ozurdex® (dexamethasone intravitreal implant 0.7mg)
For more information, please visit ozurdex.com. The doctor's office can enrol you if you are eligible.

BOTOX® (onabotulinum toxinA injection) Reimbursement Solutions PATIENT ASSISTANCE™ Program

This program provides BOTOX® at no charge to financially eligible patients. Those who may qualify include patients who are uninsured or underinsured. Allergan is proud to assist eligible uninsured and underinsured patients with their treatment through the donation of BOTOX® vials.

For more information, please visit https://www.botoxreimbursement.us/.

Cervical Dystonia Fund – National Organization for Rare Disorders-NORD

NORD’s Disease Specific Assistance Programs are designed to help patients with out-of-pocket costs associated with their insurance plans.

If you think you may be eligible for financial assistance support contact NORD at 1-855-864-4024 or Email: CervicalDystonia@rarediseases.org.

For more information, please visit rarediseases.org.