Ammonul

Indicated For

Urea cycle disorders, acute hyperammonemia, hepatic encephalopathy

About This Medication

# Bausch Health Patient Assistance Program Patient Guide: How to Get Ammonul at Low or No Cost Ammonul (sodium phenylacetate and sodium benzoate) is an intravenous medication used to treat acute hyperammonemia in patients with urea cycle disorders, helping remove excess ammonia from the blood when dietary management alone isn't enough.[1][2] The **Bausch Health Patient Assistance Program (PAP)** provides this critical drug **at no cost** to eligible uninsured or underinsured patients who meet specific criteria, including income limits and residency requirements.[1][2] ## Who Qualifies for the Program? Eligibility is determined on a **case-by-case basis**, but key requirements include:[1][2] - Being a **legal U.S. resident** (including Puerto Rico). - Having a **valid prescription** from a licensed U.S. healthcare professional for Ammonul, a product covered by the program. - Receiving treatment as an **outpatient** (not residing in a hospital, nursing home, correctional facility, or similar). - **Household income** not exceeding **300% of the Federal Poverty Level (FPL)** based on household size. - **Insurance status**: Uninsured for the Bausch Health product, denied coverage by commercial insurance (with all appeals exhausted), or lacking coverage through government programs like Medicare Part D, Medicaid (special form for Medicaid patients), Medigap, VA, DoD, TRICARE, or other federal/state pharmacy assistance.[1][2] **Medicaid patients** may qualify using a separate application, and Medicare Part D patients can appeal for review.[1][2] Discount cards do not count as coverage. Your prescriber must not be excluded from federal healthcare programs.[2] ## About Ammonul **Ammonul** is a combination of sodium phenylacetate and sodium benzoate, administered intravenously in hospital or outpatient settings for **urea cycle disorders (UCDs)**. UCDs are genetic conditions impairing the body's ability to break down ammonia, a toxic waste product from protein metabolism, leading to dangerous buildup in the blood (hyperammonemia).[1] This can cause brain swelling, coma, or death if untreated. Ammonul works by providing alternative pathways to excrete nitrogen as phenylacetylglutamine and hippurate, bypassing the defective urea cycle. It's typically used short-term during acute episodes alongside hemodialysis if needed, and patients often require lifelong management with diet, medications like sodium phenylbutyrate, and monitoring.[1][2] Always follow your doctor's instructions, as Ammonul is not a cure but a life-saving intervention. Discuss risks like injection site reactions, electrolyte imbalances, or neurotoxicity with your healthcare team.[1] ## Income Eligibility Breakdown Income eligibility is based on **total annual household income** at or below **300% of the FPL**. Use the table below for 2026 guidelines (adjust for current year via HHS.gov). Include all household members' income. | Household Size | 100% FPL | 300% FPL (Max Eligible Income) | |---------------|----------|-------------------------------| | 1 | $15,060 | $45,180 | | 2 | $20,440 | $61,320 | | 3 | $25,820 | $77,460 | | 4 | $31,200 | $93,600 | | 5 | $36,580 | $109,740 | | 6 | $41,960 | $125,880 | | +1 each | +$5,380 | +$16,140 | *Source: Approximate 2026 FPL projections; verify at aspe.hhs.gov/poverty-guidelines.*[2] Applications require income proof, reviewed individually.[1] ## Insurance Requirements The program targets those without viable coverage for Ammonul:[1][2] - **Uninsured**: No prescription coverage at all. - **Underinsured**: Denied by commercial insurance after appeals, or no coverage via government plans (Medicare Part D, Medicaid, etc.). - **Medicaid**: Eligible via dedicated form. - **Medicare Part D**: Appeal possible; all enrollees terminate Dec 31 and must reapply. Attach insurance cards (front/back). If covered, you likely won't qualify unless denied.[1][2] ## Step-by-Step Application Process 1. **Confirm Eligibility**: Review criteria above. Visit BauschHealthPAP.com for full details and Ammonul availability.[1][2] 2. **Download Form**: Get the standard application PDF or Medicaid-only version.[1] 3. **Patient Section**: Complete personal info, insurance details (page 2), sign authorization (page 3).[1] 4. **Prescriber Section**: Doctor completes clinical info, prescription, certification (pages 4-6).[1] 5. **Gather Documents**: Copy of insurance cards (front/back), proof of income (e.g., tax returns, pay stubs), pharmacy statements if applicable.[1] 6. **Submit**: **Call (855) 770-0424** for guidance, or fax to 844-705-0160 / mail to Bausch Health PAP, P.O. Box 991624, Louisville, KY 40269. Online options may be available.[1][3] 7. **Wait for Review**: No application fee; case-by-case approval.[1][2] Include authorized representative info if needed.[1] ## Timeline and Delivery Processing time varies (not specified; typically weeks).[3] Approved patients get Ammonul **free for up to 12 months** from approval date, shipped directly (details post-approval).[1][2][3] Annual reconfirmation required; report insurance/income changes. Medicare patients reapply yearly post-Dec 31.[2] ## Alternatives if Denied - **Appeal** denial if new info (e.g., insurance change).[2] - **Other PAPs**: Check RxAssist.org or Needymeds.org for UCD-specific aid. - **Manufacturer Copay Cards**: If commercially insured (not for PAP). - **State Programs**: Pharmacy assistance in your state. - **UCD Foundations**: Like National Urea Cycle Disorders Foundation for grants. - **Generic Sodium Phenylbutyrate** or alternatives like Ravicti (if covered).[2] ## Disclaimer This guide summarizes publicly available info as of 2026 and is **not official advice**. Eligibility, availability, and terms can change; **contact Bausch Health PAP at (855) 770-0424** or visit BauschHealthPAP.com for latest details. Consult your doctor for medical decisions. Bausch Health reserves discretion in approvals. Not affiliated with Bausch Health.[1][2][3] (Word count: 1028)

Program information last verified: March 30, 2026