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Galderma Laboratories Patient Assistance Program
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2730 S. Edmonds Lane
Lewisville, TX 75067
Phone
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(855)431-3737
Fax:
(855)431-3738
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Eligibility
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The patient cannot have prescription insurance, be ineligible for any federal or state programs and have an income at or below 200% of the Federal Poverty Level. Must be US resident and be treated by US doctor. |
| Who Can Apply
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Call for fax or mailed application or download from website. Return application via email, fax or mail. Patient will be notified in writing within 2-4 business days. |
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Required
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Medically appropriate condition/diagnosis required. The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Up to 30day supply. Patient must contact company for refills. Refill limit up to 2yrs. Must re-enroll at the end of each calendar year. |
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Ship To
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Shipped to patient's home within 5-7 business days. |
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Note
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Anyone can write the company to request an application. |
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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.
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| Epiduo gel; topical |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Galderma Laboratories Patient Assistance Program |
(Requires Acrobat Reader) 
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