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Allergan Patient Assistance Program

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  • Allergan Patient Assistance Program

    Since Restasis ain't cheap, I thought this might help some people. I got this info from the Partnership for Prescription Assistance's website ( On their website you select which medication you take and then you can see if there is an assistance program for it.

    Allergan Patient Assistance Program


    Contact Information
    Allergan Patient Assistance Program
    PO Box 4015
    Clinton, NJ 08809
    1-(800) 553-6783 (phone)
    1-(908) 713-7736 (fax)

    Physician requests should be directed to:
    Allergan Patient Assistance Program
    PO Box 4015
    Clinton, NJ 08809
    1-(800) 553-6783 (phone)

    Product(s) covered by program:
    Alphagan® P 0.15%
    Lumigan® .03% Q.D.
    Restasis® .15%
    TAZORAC CREAM .05% ®
    TAZORAC GEL .05% ®
    TAZORAC GEL .1% ®

    Allergan Patient Assistance Program Application

    The objective of the Patient Assistance Program is to provide assistance to patients who are not eligible for Medicare Part D and are without another form of drug coverage and cannot afford their medications. Patients must reside in the United States and be under the care of a U.S. based physician and not be eligible for drug coverage by any private or public assistance program such as Medicare or Medicaid. Annual household income limits do apply but each case is reviewed on an individual basis.

    Other Information:
    Who Can Apply:

    * Physician's office may apply on patient's behalf.


    * Physician may complete the application on line sign & fax the request form attesting to need of the patient. Physician's state license or Optometrist's TPA number is required.
    * Patient's signature is required as well as proof of income


    * 6 month supply; reorder after 5 months.

    Ship To:

    * Physician's Office, to be provided to the patient at the Physician's Office.


    * Patient request forms must be filled out completely, signed by the Physician, and faxed or mailed in with appropriate proof of need. (see instruction page of the application)

  • #2
    Allergan also has a rewards program that is tastefully called "My Tears, My Rewards."

    After using seven boxes of Restasis and submitting a coupon and receipt from each one, you get one box free. You also have to answer a bunch of survey questions before you sign up, and you must also sign up for a bunch of their marketing crap (newsletters, surveys, etc.)

    This program is pretty labor-intensive and you'll probably be bombarded with junk mail from Allergan if you sign up, so it's probably only worthwhile if you don't have any prescription drug coverage.


    • #3
      I was sooo amused when I saw the title of the program myself. Every time I receive letters, etc my husband tells me "Hey, you've got mail from the Tears for Fears fan club..."

      After an evening of brainstorming, I decided that I would write Allergan a letter suggesting that the program be renamed "Tears of Joy". Much better,eh?

      However, the reason I'm posting this message is to say that participation in this program isn't a burden. You do answer a couple of questions online on enrollment and mail your receipts along with the 7 coupons. I just mailed my 7th.

      I'm really not sure if Restasis is really helping by the way, but I'm not that much in the mood of stopping it just to find out


      • #4
        People, I'm very, very upset with this program...

        I went to refill my RX today, and was happy because I would get 1 tray free, right? Wrong Turns out that when you buy Restasis through insurance and get one tray "free", you still get to pay 35$ (same co-pay as before) to get the second (aka, a month's supply).

        So, I assume this program is useless unless someone has no insurance coverage and pays the entire 200$ out of pocket (which is a fairly high amount for Restasis, imho).