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| Program Contact Info / Application Submission |
| Program | Biovail Patient Assistance Program | | Company | BIOVAIL | | Form | Download PDF | | Address | PO Box 836 Somerville, NJ 08876 | | Phone | 866-268-7325 | | |
| Program Details |
| Details | Up to a 90-day supply is sent to the doctor's office. A new application with new prescription is needed for refills. Once a year a new application with financial documentation is needed.
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| Program Requirements |
| Information | The doctor must fill out a section, sign the application and attach a prescription for 90 days. The patient must fill out a section, sign the application and attach proof of income.
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| Delivery of Medication |
| Ship Time | 4-6 weeks | | |
| Application Process |
| App Process | With the patient's permission, anyone concerned can call for an application. The application will be faxed out. The completed application must be mailed back. Both the patient and doctor are notified in writing of acceptance or denial. The medication is shipped out within 5-7 business days.
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| Eligibility |
| Eligibility | The patient must have no prescription coverage for any medications and have an income at or below 200% of the Federal Poverty Level. The patient must also be a US resident. If a patient enrolls in Medicare Part D, then s/he is no longer eligible for this program. If the patient chooses not to enroll in Part D, then s/he is still eligible to be on this program. There is some assistance available for Vasotec, call the company for more details | | |
| Other Medications |
Other
Medications
available in
this program | |
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