Allergan (Actavis) Patient Assistance Program

Requirements for uninsured applicants

• Annual household income limits to apply to this program but are not posted, each case is reviewed on an individual basis
  • View federal poverty guidelines
• Medication is shipped to the prescriber’s office only, they will not ship to the patients home
• Applications are good for 1 year from approval date

Requirement for Medicare Part D applicants

• Medicare part D enrollees must have applied and been denied for the LIS before they can be approved for this program
• Medicare part D enrollees Applications for Medicare part D enrollees are valid until December 31st of current year