Alocril

Indicated For

allergic conjunctivitis

About This Medication

# Allergan Patient Assistance Program Patient Guide: How to Get Alocril at Low or No Cost ## About This Program The Allergan Patient Assistance Program, operated by AbbVie, provides prescription medications at no cost to eligible patients who cannot afford their medications. This program is designed to help uninsured patients, those with limited insurance coverage, and individuals who demonstrate financial need access the medications their doctors have prescribed. ## About Alocril (Nedocromil) Alocril is an ophthalmic medication used to treat allergic conjunctivitis (eye allergies). As a prescription eye drop, it helps reduce itching, redness, and other symptoms associated with allergic reactions affecting the eyes. Your doctor has determined that Alocril is the right medication for your condition. ## Who Qualifies for This Program? You may be eligible for the Allergan Patient Assistance Program if you meet these criteria: - You live in the United States - You are uninsured, have limited health insurance coverage, or your insurance does not adequately cover the cost of your medication - You demonstrate financial need - You have a valid prescription from a licensed healthcare provider The program is available to patients regardless of Medicare status, though Medicare beneficiaries have specific enrollment requirements (see Insurance Requirements section below). ## Income Eligibility While specific income thresholds for the Allergan Patient Assistance Program are not publicly detailed in standard materials, the program uses a financial need assessment to determine eligibility. During your application, you will provide information about your household income, expenses, and financial situation. A patient advocate will review this information to determine whether you qualify. Generally, the program is designed for patients with limited financial resources who cannot afford their medications out-of-pocket. ## Insurance Requirements You do not need to have insurance to apply for this program. In fact, the program is specifically designed for: - **Uninsured patients**: Those with no health insurance coverage - **Underinsured patients**: Those whose insurance does not adequately cover Alocril - **Medicare beneficiaries**: If you are enrolled in Medicare (including Medicare Prescription Drug plans), you can still qualify for assistance. However, while enrolled in the Allergan Patient Assistance Program, you cannot purchase the medication through your Medicare plan or submit claims for reimbursement. ## How to Apply: Step-by-Step **Step 1: Gather Required Information** Before starting your application, have the following ready: - Your prescription from your doctor - Proof of income (recent pay stubs, tax returns, or benefit statements) - Information about your household size and expenses - Your insurance information (if applicable) - Your doctor's contact information **Step 2: Contact the Program** You can apply in two ways: - **By phone**: Call 1-844-424-6727 to speak with a representative who can mail or email you an application - **Online**: Visit www.allergan.com/patient-assistance-programs to download an application **Step 3: Complete Your Application** Fill out the application form completely and accurately. The application will ask about your medical history, current medications, insurance status, and financial situation. Be thorough—incomplete applications may delay your approval. **Step 4: Gather Supporting Documentation** Include the following documents with your application: - Proof of income (pay stubs, tax returns, Social Security statements, or unemployment benefits documentation) - Proof of residency (utility bill or lease agreement) - Your prescription or a letter from your prescriber - Insurance card (front and back) if you have coverage **Step 5: Submit Your Application** Mail or fax your completed application and documentation to: Allergan Patient Assistance Program PO Box 66764 St. Louis, MO 63166 Fax: 1-844-708-0036 Alternatively, you can submit your application through a patient advocacy organization like Simplefill, which can help guide you through the process. **Step 6: Await Approval** After submitting your application, the program will review your information and notify both you and your prescriber about your eligibility status. ## Timeline and Medication Delivery **Processing Time**: The program typically reviews applications within 1-2 weeks, though this may vary depending on application volume and completeness. **Approval Duration**: If approved, you will receive assistance for up to 12 months from your approval date. **Medication Delivery**: The program ships most products in a 90-day supply. Your medication will be delivered to your prescriber's office, where you can pick it up. The program will resend your medication every three months during your 12-month enrollment period. **Cost**: There are absolutely no fees to participate in this program. You will not pay any co-pays, shipping costs, or application fees. ## What Happens If Your Application Is Denied? If you do not qualify for the Allergan Patient Assistance Program, you have several options: - **Ask why you were denied**: Contact the program at 1-844-424-6727 to understand the reason for denial. You may be able to reapply if your circumstances change. - **Explore other assistance programs**: Other manufacturers may offer similar programs for alternative medications your doctor could prescribe. - **Contact patient advocacy organizations**: Groups like Simplefill (1-877-386-0206) can help you find other resources and assistance programs. - **Discuss generic alternatives**: Ask your doctor if there are generic or lower-cost alternatives to Alocril that might be covered by your insurance or available through other assistance programs. ## Reauthorization and Program Renewal Your assistance is approved for up to 12 months. Before your enrollment period ends, the program will contact you about reauthorization. You will need to: - Reapply for the program - Provide updated financial and insurance information - Submit any required documentation again If your insurance or financial situation changes during your enrollment, notify the program immediately at 1-844-424-6727. Changes may affect your eligibility or the terms of your assistance. ## Important Reminders - **Notify the program of changes**: If you obtain insurance, your financial situation improves, or your prescription changes, contact the program right away. - **Annual renewal required**: You must reapply each year to continue receiving assistance. - **Medicare restrictions**: If you are on Medicare, you cannot use your Medicare plan to purchase this medication while enrolled in the patient assistance program. - **No reimbursement**: You cannot seek reimbursement for medications received through this program. ## Contact Information **Allergan Patient Assistance Program** - Phone: 1-844-424-6727 - Fax: 1-844-708-0036 - Mailing Address: PO Box 66764, St. Louis, MO 63166 - Website: www.allergan.com/patient-assistance-programs **For General AbbVie Patient Support** - Visit: AbbVie.com/PatientAccessSupport - Phone: 1-800-332-1088 ## Disclaimer This guide provides general information about the Allergan Patient Assistance Program. Program details, eligibility requirements, and available medications may change without notice. For the most current and accurate information, contact the program directly using the contact information above. This guide is not a guarantee of eligibility or approval. All eligibility determinations are made by the Allergan Patient Assistance Program based on individual circumstances.

Program information last verified: March 30, 2026