Besivance Patient Assistance Programs

Besivance: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Besivance. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Bausch Health Patient Assistance Program

(Program 1 of 1 — Scroll down to see them all )

Provided by: Bausch Health Companies, Inc.
None
TEL: 833-862-8727
FAX: 866-777-5705
Languages Spoken:
English, Spanish
Program Website
Medications
  • Besivance (besifloxacin)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Determined case by case
  • Income Based on FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Must be a US resident and treated by a US licensed healthcare provider
Application
  • Obtaining Call
  • Receiving Faxed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit One year
  • Re-application New application yearly
Additional Information
Hardship appeals for patients residing in Puerto Rico will be reviewed on a case-by-case basis. Call for information on the most recent medications as the list is subject to change.
Updated November 12, 2018

Back to top