ICN Patient Assistance Program

ICN Pharmaceuticals,

Contact Information
ICN Plaza
3300 Hyland Ave
Costa Mesa, CA 92626
1-(800) 556-1937 option4 (phone)
1-(714) 641-7289 (fax)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
  • Click here to visit the program's web site.
  • Eligibility:
    Eligibility is based on income and lack of insurance.
    Other Information:
    They will only provide three months of medication per year unless prescriber writes a letter indicating that patient needs more than that.
    Product(s) covered by program:
    • 8-Mop
    • Ancobon
    • Benoquin
    • Efudex®
    • Eldopaque Forte
    • Eldoquin Forte
    • Fototar
    • Oxsoralen Ultra®
    • Oxsoralen®
    • Solaquin Forte
    • Tensilon
    • Virazole