US Patient Assistance Program

Alcon Labs

Contact Information
U.S. Patient Assistance Program
Humanitarian Services T7-18
6201 South Freeway
Ft. Worth, TX 76134
1-(800) 222-8103 option2 (phone)
1-(817) 568-6644 (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:
    Patient cannot have a prescription reimbursment insurance, must be indigent and needy, and physician must be an optometrist or ophthalmologist.
    Other Information:
    New applications are required for refills.
    Product(s) covered by program:
    • Azopt®
    • Betoptic S®
    • Bion Tears
    • Brimonidine Tartrate
    • Carteolol HCl
    • Ciloxan Ointment
    • Ciloxan Solution
    • Cipro HC Otic
    • Ciprodex
    • Econopred Plus
    • Flarex®
    • Iopidine
    • IsoptoCarbachol
    • IsoptoCarpine
    • Levobunolol HCl
    • Maxitrol Suspension
    • Metipranolol Solution
    • Pilopine HS
    • Systane
    • Tears Naturale Forte
    • Tears Naturale Free Lubricant Eye Drops
    • Tears Naturale PM Ointment
    • Timolol Maleate
    • TobraDex Ophthalmic Ointment
    • TobraDex Suspension
    • Travatan
    • Unisol 4 Saline
    • Vexol
    • Vigamox