You must be a legal United States resident.
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:
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).
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.