Valeant Pharmaceuticals International Patient Assistance Program

Valeant Pharmaceutic

Contact Information
Valeant Pharmaceuticals International Patient Assistance Program
P.O. Box 5836
Somerset, NJ 08875
1-(800) 511-2120 (phone)
1-(732) 507-7610 (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.
Eligibility for this program is based on financial need. Doctor and Patient must sign the application. The prescription for the brand name is required. Application can be initiated online or faxed.
Other Information:
Healthcare providers or patients can initiate the application process.
Product(s) covered by program:
  • 8-MOP®
  • Ancobon
  • Cesamet™
  • Diastat® Acudial™ 10mg
  • Diastat® Acudial™ 20mg
  • Diastat®Gel 2.5mg
  • Mestinon® 60 mg/180 mg
  • Mestinon® Syrup
  • Migranal®
  • Oxsoralen® Lotion
  • Oxsoralen-Ultra® Capsules, 10mg
  • Prostigmin®
  • Tasmar®
  • Zelapar®