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Bausch and Lomb Indigent Patient Program

Summary

Bausch & Lomb was formed as an eye health company in 1853 Rochester, New York. Their focus in the eye health field covers five broad categories: Contact Lenses, Lens Care, Pharmaceuticals, Cataract and Vitreoretinal Surgery, and Refractive Surgery. In over 150 years, Bausch & Lomb has become a leader in the developer and innovator of all things related to eye health. With their products distributed in over 100 countries and an employee base of nearly 13,000, Bausch & Lomb is considered to be a global authority for their field.

Alrex is a anti-inflammatory corticosteroid launched by Bausch and Lomb in 1998. Alrex has been approved by the FDA for treatment of seasonal allergic conjunctivitis. Alrex is administered topically.

Lotemax is a ophthalmic corticosteroid launched by Bausch and Lomb in1998. Lotemax has been approved by the FDA for treatment of swelling, itching, redness, or irritation of the eye . Lotemax is administered topically.

Eligibility

Bausch And Lomb Indigent Patient Program, a patient assistance program provided by Bausch and Lomb, offers Alrex and Lotemax at no cost to those who are eligible for the program. Eligibility is based off of the following requirements:

- You must not be covered by any private, public, or Medicare Part D prescription coverage programs.

- Your annual income must be no greater than $19,600 if single, but no greater than $26,400 for your entire household.

The medication must be sent to the physicians office.

SOURCE: 2008 Poverty Chart
Family Size
300%
250%
200%
150%
133%
100%
1
$32,490
$27,075
$21,660
$16,245
$14,404
$10,830
2
$43,710
$36,425
$29,140
$21,855
$19,378
$14,570
3
$54,930
$45,775
$36,620
$27,465
$24,352
$18,310
4
$66,150
$55,125
$44,100
$33,075
$29,327
$22,050
5
$77,370
$64,475
$51,580
$38,685
$34,301
$25,790
6
$88,590
$73,825
$59,060
$44,295
$39,275
$29,530
7
$99,810
$83,175
$66,540
$49,905
$44,249
$33,270
8
$111,030
$92,525
$74,020
$55,515
$49,223
$37,010
Each Additional Family Member
$11,220
$9,350
$7,480
$5,610
$4,974
$3,740

What´s Next?

Fill out the program enrollment form located to your right. If you don't see an enrollment form available please call Bausch and Lomb program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.

Other Tips

  • If you have any questions please call the Bausch and Lomb program directly.
  • Fill out as much of the information on the enrollment form as possible. The more information you have pre-filled the easier the progrm is to enroll in.
  • Write down the refill dates for your program and set a reminder here on PatientAssistance.com so that you don't run out of medication.
  • Do not write messy on your forms as this will delay any response.
  • Call and write thank you notes to AAI Pharma Inc. program. Without their help millions of people will be without medication.

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