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 Bausch Health Patient Assistance Program (BHC PAP).
You do not reside in a hospital, nursing home, correctional facility or court-appointed program or facility.
You must submit a copy from the pharmacy of your total Out-Of-Pocket cost (OOP) that you are responsible for to access your prescription
If you appear to be eligible for the Medicare Part D Low-Income Subsidy (LIS) you will be required to access that coverage first. If denied, you will need to provide a copy of the LIS denial letter to be considered for enrollment in the BHC PAP.
In terms of health insurance, you must:
be uninsured
or, be denied coverage for Bausch Health product by your commercial insurance provider and have exhausted all appeal options; or,
or, not have coverage for the Bausch Health product requested through government health insurance, (i.e., Medicare Part D, Medicaid, Medigap, VA, DoD, TRICARE or other federal or state pharmacy assistance programs).
If you have coverage for the Bausch Health product requested through 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).
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 Bausch Health Patient Assistance Program.
No product provided through the Bausch Health Patient Assistance Program may be sold, traded, or returned for credit.
Bausch Health Companies, Inc., has the right to verify your eligibility, including the right to audit any information provided on the Bausch Health Patient Assistance Program 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.
Bausch Health Companies, Inc., in its sole discretion can determine your participation in the Bausch Health Patient Assistance Program.
Approved patients are eligible to receive assistance for up to 12 months from the date of approval.
All Medicare Part D enrollees will be terminated on 31 December and must reapply to stay in the BHC PAP for the following year.
Bausch Health Patient Assistance Program 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 Bausch Health Patient Assistance Program, 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 Bausch Health Patient Assistance Program 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.
Bausch Health Patient Assistance Program benefits, rules, and product availability are subject to change at any time without prior notification.
