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Patient Assistance Information

 
2 Programs for Zovirax Cream
 
 
Biovail Pharmaceuticals Patient Assistance Program

PO Box 836
Somerville, NJ 08876
Phone : 866-268-7325
Fax: Not Applicable
Eligibility
> The patient must have no prescription coverage for any medications and have an income at or below 200% of the Federal Poverty Level. The patient must also be a US resident.
Who Can Apply
> With the patient's permission, anyone concerned can call for an application.
Required
> The doctor must fill out a section, sign the application and attach a prescription for 90 days.The patient must fill out a section, sign the application and attach proof of income.
Supply
> Up to a 90-day supply
Ship To
> Doctor's office
Note
> With the patient's permission, anyone concerned can call for an application.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Zovirax Cream
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
Valeant Patient Assistance Program

PO Box 836
Somerville, NJ 08876
Phone : (866)268-7325
Fax: (866)217-7164
Eligibility
> Patient must have no prescription coverage, be at or below 200% of the Federal Poverty Level and be a US citizen or legal resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or mailed.
Required
> Doctors must complete a section of the application, sign and attach a prescription. Patients must also complete a section and sign.
Supply
> Up to 90 day supply
Ship To
> Doctor's office
Note
> Wellbutrin XL IS NOT AVAILABLE FOR NEW PATIENTS. Call for information on the most recent medications as the list is subject to change.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Zovirax Cream