Xen Patient Assistance Programs

Xen: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Xen. 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?

Allergan Patient Assistance Program: Xen Sterile Injector

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

Provided by: Allergan, Inc.
TEL: 844-424-6727
FAX: 513-618-0067
Languages Spoken:
Program Website
  • Xen sterile injector (injector sterile injector)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Not specified
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be treated by US licensed healthcare provider
  • Obtaining Call or download
  • Receiving Faxed, emailed or downloaded from website
  • Returning Email or fax
  • 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
  • Amount/Supply Varies
  • Sent To Licensed Health Care Provider
  • Delivery Time Not specified
  • Refill Proces Doctor/Doctor's office must contact the Program
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
Updated August 9, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Xen prices here.

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