Besivance

Indicated For

bacterial conjunctivitis

About This Medication

# Bausch + Lomb Patient Assistance Program Patient Guide: How to Get Besivance (besifloxacin) at Low or No Cost Besivance (besifloxacin) is a prescription eye drop used to treat bacterial conjunctivitis, commonly known as pink eye. The **Bausch + Lomb Patient Assistance Program** offers this medication **free** to eligible patients who are uninsured or underinsured and cannot afford their treatments. This guide explains everything you need to know to apply, qualify, and get your medication quickly and easily. ## About Besivance (besifloxacin) **Besivance** is an antibiotic eye suspension specifically designed to fight bacteria causing conjunctivitis. It's typically prescribed for adults and children 1 year and older. Each bottle contains a sterile, preserved formulation that you apply directly to the affected eye, usually 3 times a day for 7 days. Common side effects include mild eye redness or discomfort, but it's generally well-tolerated. Always follow your doctor's instructions and complete the full course to prevent resistance. If you have bacterial pink eye and struggle with costs, this program can provide relief by delivering free bottles to you or your doctor's office (maximum one bottle per request).[1] ## Who Qualifies for the Program? The program is for **uninsured or underinsured patients** who cannot afford their Bausch + Lomb medications, including Besivance. This includes: - Patients with **limited or no insurance coverage**. - **Medicaid patients** affected by changes as of October 1, 2025, when Bausch Health stopped participating in certain federal programs—your plan may no longer cover it, but you could still get it free here.[1] - Those facing financial hardship. Exact income limits aren't detailed publicly, but third-party sources suggest guidelines like around $40,000 for individuals, $60,000 for couples, and up to $100,000 for larger families (these can vary—confirm during application).[provided data] ## Income Eligibility Breakdown Income eligibility is based on federal poverty level (FPL) or fixed limits, though specifics aren't listed on the official site. Here's a general table based on common patient assistance thresholds and advocate reports (always verify with the program): | Household Size | Estimated Annual Income Limit | Notes | |---------------|-------------------------------|-------| | 1 (Individual) | Up to ~$40,000 | Varies; call to confirm[provided data] | | 2 (Couple) | Up to ~$60,000 | Approximate; subject to change | | 3 | Up to ~$75,000 | Based on advocate mentions | | 4+ (Family) | Up to ~$100,000 | Larger families may have higher thresholds | **FPL Percent:** Not specified, but often 400-500% of FPL for similar programs. Contact the program for your exact situation—no cost to apply.[1][provided data] ## Insurance Requirements - **Uninsured patients** qualify easily if they meet income criteria. - **Underinsured** (high copays, deductibles, or non-coverage) are eligible. - **Medicare patients:** May qualify if Part D doesn't cover or costs are unaffordable. - **Medicaid patients:** Special eligibility post-October 2025 changes.[1] - Commercial insurance patients can apply if they can't afford out-of-pocket costs. The program prioritizes those with **limited or no insurance** who need Bausch + Lomb meds like Besivance.[1][provided data] ## Step-by-Step Application Process Applying is simple with **multiple methods**—takes just minutes! 1. **Gather Info:** Have your doctor's prescription for Besivance, personal details, income proof (if requested), and insurance info ready. 2. **Choose Your Method:** - **Online:** Visit bauschhealthpap.com and download the form (select 'I am on Medicaid' or 'not on Medicaid').[1] - **Phone:** Call **1-833-862-8727** (Mon-Fri, 8am-8pm EST) to apply over the phone—no fax or mail needed.[1] - **Mail/Fax:** Send the downloaded form.[1] 3. **Submit:** Include your prescription. Your info stays **secure and confidential**.[1] 4. **Wait for Review:** Program reviews quickly. **No application fee.** Doctors often help complete forms.[provided data] ## Timeline and Delivery - **Processing:** Approvals in **as little as 24-48 hours**.[1] - **Delivery:** If approved, **free medication shipped to your home** or physician's office—no copays or shipping fees. Maximum **one bottle per request**.[1][provided data] - **Supply Duration:** Up to **1 year** of medication; reapply annually if still eligible with a valid prescription.[1] ## Alternatives if Denied or Ineligible - **Reapply:** Fix issues and try again. - **Other Programs:** Check Partnership for Prescription Assistance (pparx.org) or NeedyMeds.org for Besivance alternatives. - **Generic Options:** No generics for besifloxacin yet; consider doctor switches to other antibiotics like erythromycin ointment. - **Manufacturer Coupons:** Bausch + Lomb may have savings cards via your pharmacy. - **State Programs:** Local Medicaid or charity clinics. - **Low-Cost Clinics:** Community health centers offer affordable eye care. **Biosimilars:** None available for Besivance.[provided data] ## Important Disclaimer This guide is for informational purposes based on available program details as of March 2026. Eligibility, rules, and availability can change—**always contact Bausch + Lomb directly at 1-833-862-8727 or bauschhealthpap.com for the latest info**. Not medical advice; consult your doctor for treatment. Income estimates from third parties may not match official criteria. Program provides free meds but doesn't cover non-medication costs. Bausch + Lomb reserves rights to modify or end the program.[1][provided data]

Program information last verified: March 30, 2026