Maxitrol

Indicated For

post-surgical eye inflammation, bacterial eye infections

About This Medication

# Alcon Patient Assistance Program Patient Guide: How to Get Maxitrol (neomycin polymyxin dexamethasone) at Low or No Cost Maxitrol is an eye drop medication combining **neomycin**, **polymyxin B**, and **dexamethasone** used to treat bacterial eye infections and reduce inflammation. The **Alcon Patient Assistance Program** (also known as Alcon Cares) provides this medication at no cost to eligible uninsured or underinsured U.S. patients meeting strict income and residency guidelines.[1][2][6] ## About Maxitrol **Maxitrol** is a prescription ophthalmic suspension prescribed for ocular inflammatory conditions with bacterial infection or risk of infection, such as conjunctivitis or post-surgical inflammation. It contains three active ingredients: - **Neomycin sulfate** (antibiotic targeting bacteria). - **Polymyxin B sulfate** (antibiotic effective against gram-negative bacteria). - **Dexamethasone** (corticosteroid to reduce swelling and redness). Always use as directed by your doctor. Common side effects include temporary stinging or blurred vision; contact your healthcare provider for persistent issues. This program helps ensure access when costs are a barrier.[1][2] ## Who Qualifies? To qualify for free Maxitrol through the Alcon Patient Assistance Program, you must: - Be a **U.S. resident** (or legal guardian for minors). - Have **no prescription insurance** or qualify for local/state/federal programs only with **documented financial hardship**. - Meet **income eligibility** at or below **200% of the Federal Poverty Level (FPL)** based on household size. - Be treated by a U.S.-licensed physician who confirms medical need and inability to afford the medication.[1][2][6] **Note:** Medicare Part D patients may have separate coupon options (e.g., $60 for certain products), but the Patient Assistance Program is primarily for uninsured/low-income individuals.[1][7] ## Income Eligibility Breakdown Eligibility is based on **200% of the current Federal Poverty Level (FPL)** for your household size. FPL guidelines are updated annually by the U.S. Department of Health and Human Services. Below is a sample table using 2026 guidelines (check HHS.gov for exact current figures, as they adjust yearly). | Household Size | 100% FPL (Annual) | 200% FPL (Annual) | 200% FPL (Monthly) | |----------------|-------------------|-------------------|--------------------| | 1 (Individual) | $15,060 | **$30,120** | **$2,510** | | 2 (Couple) | $20,440 | **$40,880** | **$3,407** | | 3 | $25,820 | **$51,640** | **$4,303** | | 4 | $31,200 | **$62,400** | **$5,200** | | +1 per person | +$5,380 | **+$10,760** | **+$897** | *Proof of income required: recent federal tax return, pay stubs, or other household income verification.* Assets, medical needs, and other factors may also be reviewed.[2][6] ## Insurance Requirements This program targets patients **without prescription insurance**. If you have private insurance, explore Alcon's **Copay Assistance** or **Direct Access Support Coupons** instead.[1] Medicare Part D enrollees are generally ineligible unless facing extraordinary hardship; use Medicare-specific coupons where available (e.g., $60-$79 for select products). Those qualifying for Medicaid/State programs must show **documented denial or financial hardship** to participate.[1][2][6][7] ## Step-by-Step Application Process 1. **Contact for Application:** Call **1-800-222-8103** (Alcon Cares) to request the form, or ask your doctor to obtain it. Applications can be downloaded from MyAlcon.com or copied.[1][2][6] 2. **Complete Section 1 (Patient):** Provide personal details, household income/assets, Social Security number, and medical info. Include **proof of income** (e.g., tax return, pay stubs).[2] 3. **Doctor Completes Section 2:** Your healthcare provider verifies diagnosis, prescribes Maxitrol, and signs.[2][3] 4. **Submit:** **Fax to 800-554-2660** or **mail to Alcon Cares, Inc., TB3-4, 6201 South Freeway, Fort Worth, TX** (exact address on form).[2] 5. **Wait for Approval:** Approved apps are valid for **one year**.[2] **Tip:** Ensure completeness—**incomplete applications are rejected**.[2] ## Timeline and Delivery Processing time varies (typically 2-4 weeks based on similar programs; call 1-800-222-8103 for status).[2] Once approved, Maxitrol is **shipped free to your doctor's office or home**—no charges to you or your provider.[1][2][6] For refills/renewals: Check 'renewal' box on original Page 1, complete new Page 2, and resubmit with originals.[2] ## Alternatives if Denied - **Appeal:** Review denial letter (sent with reasons) and resubmit with additional proof.[2] - **Other Programs:** RxHope.com, NeedyMeds.org, or Partnership for Prescription Assistance (PPARx.org).[2] - **Copay Cards:** Insured? Use Alcon Copay Assistance or BlinkRx.[1] - **Generic Options:** Ask your doctor about affordable alternatives. - **State Assistance:** Local Medicaid or charity clinics. - **No Biosimilars** available for Maxitrol.[6] ## Important Disclaimer This guide is for informational purposes only and based on publicly available program details as of 2026. Eligibility, guidelines, and availability can change—**always verify with Alcon at 1-800-222-8103 or myalcon.com/payment-assistance-programs/**. Not affiliated with Alcon. Consult your doctor before starting/stopping medication. Alcon reserves rights to modify/terminate the program.[1][2] (Word count: 942)

Program information last verified: March 30, 2026