Registered Users Log-in:

E-mail Address:


Forgot Password?
Patient Assistance Information

1 Program for Soolantra cream
Galderma Laboratories Patient Assistance Program

2730 S. Edmonds Lane
Lewisville, TX 75067
Phone : (855)431-3737
Fax: (855)431-3738
> 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
> 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.
> 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.
> 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.
Ship To
> Shipped to patient's home within 5-7 business days.
> Anyone can write the company to request 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.
Soolantra cream
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form Galderma Laboratories Patient Assistance Program
(Requires Acrobat Reader