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Patient Assistance Information

1 Program for Ilevro ophthalmic suspension/drops
Xubex Pharmaceutical Services

PO Box 1244
Winter Park, FL 32790-1244
Phone : 866-699-8239
Fax: 407-671-7960
> Patients may have insurance. There are no income limits for this program. Patients must be a US resident.
Who Can Apply
> Anyone requesting assistance can call to request a faxed application or download it from the website.
> The doctor needs to provide a prescription to the patient.The patient must fill out a section and sign the application.
> Varies
Ship To
> Either Doctor's office or Patient's home
> No proof of income is required. Check the website for the exact price. This service is not currently available in Montana.
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.
Ilevro ophthalmic suspension/drops
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
(Requires Acrobat Reader