Eligibility Requirements & Terms and Conditions

You must be a legal United States resident.

»
Hardship appeals for patients residing in Puerto Rico will be reviewed by the Valeant Patient Assistance Program (Valeant PAP) on a case-by-case basis.

You are being treated as an outpatient and have a valid prescription from a licensed U.S. healthcare professional for a product that is included in the Valeant PAP.

You do not reside in a hospital, nursing home, correctional facility or court-appointed program or facility.

In terms of health insurance, you must:

»
be uninsured;
»
be denied coverage for Valeant product by your commercial insurance provider and have exhausted all appeal options; or,
»
not have coverage for the Valeant product requested through government health insurance, (i.e., Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, TRICARE or other federal or state pharmacy assistance programs).

If you have coverage for the Valeant product requested through Medicare Part B or Medicare Part D, you may appeal for evaluation of  eligibility. Appeals will be reviewed on a case-by-case basis.

Discount cards are not considered prescription drug coverage for purposes of program eligibility.

Your annual household income must not exceed 300% of the Federal Poverty Level (“FPL”) based on household size 
(Federal Poverty Level Guidelines available at https://aspe.hhs.gov/poverty-guidelines).

»
For valid prescriptions for CUPRIMINE®, DEMSER®, SYPRINE®, or TARGRETIN®, your annual household income must not exceed 500% of the FPL;
»
For valid prescriptions for MACUGEN®, RETISERT®, or VISUDYNE®, your annual household income must not exceed $100,000.
»
NOTE: Child support, food stamps, and/or alimony are not included in your income calculation.

You may be asked to submit documentation (e.g., federal tax returns; IRS forms such as W-2, 1099, 4506T; Social Security statement/checks/benefit letter; pension or disability benefit statement/letter; unemployment compensation statement; pay stubs) to  validate levels of income.

If you have no income, your prescriber or patient advocate must sign a letter attesting to that.

You and your prescriber may not bill, charge, seek credit for or otherwise submit any claim for reimbursement to any third party payer for product provided through the Valeant PAP.

No product provided through the Valeant PAP may be sold, traded, or returned for credit.

Valeant Pharmaceuticals, Inc., has the right to verify your eligibility, including the right to audit any information provided on the Valeant PAP application form.

Your prescriber must not be on the List of Excluded Individuals and Entities maintained by the Office of Inspector General, U.S. Department of Health and Human Services, or prohibited from participating in federally funded health care programs.

Valeant Pharmaceuticals, Inc., in its sole discretion can determine your participation in the Valeant PAP.

Approved patients are eligible to receive assistance for up to 12 months from the date of approval.

Valeant PAP will reconfirm continued income and insurance eligibility annually. If you have a change in insurance status or income, you may be deemed no longer eligible for the program.

If you were previously denied enrollment in the Valeant PAP, you may reapply if you experience a change in circumstance impacting your eligibility.

The program requires that you re-enroll every year by completing a Valeant PAP application form. A notice regarding re-enrollment will be sent to you 60 days prior to the anniversary date of your participation in the program or, in some cases, by December 31.

Valeant PAP benefits, rules, and product availability are subject to change at any time without prior notification.