Noritate

Indicated For

rosacea

About This Medication

# Bausch Health Patient Assistance Program: How to Get Noritate (Metronidazole) at Low or No Cost ## About This Program The Bausch Health Patient Assistance Program (BHC PAP) is designed to help uninsured and underinsured patients access prescription medications manufactured by Bausch Health, including Noritate (metronidazole), at no cost or reduced cost. This program recognizes that medication affordability is a significant barrier to treatment and aims to ensure eligible patients can access the medications their doctors prescribe. ## Who Qualifies for This Program? You may be eligible for the Bausch Health Patient Assistance Program if you meet all of the following criteria: - You are a **legal United States resident** (including Puerto Rico) - You have a **valid prescription** from a licensed U.S. healthcare professional for Noritate or another Bausch Health product - You are being treated as an **outpatient** (not hospitalized, in a nursing home, correctional facility, or court-appointed program) - You meet specific **income requirements** based on the Federal Poverty Level (FPL) - You meet the program's **insurance requirements** (see section below) ## Income Eligibility Your annual household income must not exceed **300% of the Federal Poverty Level (FPL)** based on your household size. The Federal Poverty Level is adjusted annually and varies by family size. | Household Size | 2026 Federal Poverty Level | 300% of FPL (Maximum Income) | |---|---|---| | 1 person | $15,060 | $45,180 | | 2 people | $20,440 | $61,320 | | 3 people | $25,820 | $77,460 | | 4 people | $31,200 | $93,600 | | 5 people | $36,580 | $109,740 | | 6 people | $41,960 | $125,880 | | 7 people | $47,340 | $142,020 | | 8 people | $52,720 | $158,160 | *Note: For households larger than 8 people, add $5,380 for each additional person to the 8-person poverty level, then multiply by 3.* Your household income includes all earnings from all household members. You will need to provide proof of income as part of your application. ## Insurance Requirements The program has specific rules about insurance coverage: **You are eligible if you are:** - Completely **uninsured**, OR - **Denied coverage** for Noritate by your commercial insurance and have exhausted all appeal options, OR - **Not covered** for Noritate through government health insurance (Medicare Part D, Medicaid, Medigap, VA, DoD, TRICARE, or other federal/state pharmacy programs) **Special Medicare Part D Situation:** If you have Medicare Part D coverage for Noritate, you may appeal for eligibility evaluation on a case-by-case basis. **Important Note:** Discount cards are not considered prescription drug coverage for eligibility purposes. ## About Noritate (Metronidazole) Noritate is a topical antibiotic medication used to treat rosacea and certain bacterial skin infections. It works by reducing bacteria and inflammation on the skin. Your doctor has determined that this medication is appropriate for your condition and has written a prescription for you. ## How to Apply: Step-by-Step Instructions ### Step 1: Gather Required Documents Before starting your application, collect the following: - Your **valid prescription** for Noritate from your healthcare provider - **Proof of income** (recent pay stubs, tax returns, Social Security statements, or unemployment benefits documentation) - **Proof of residency** (utility bill, lease agreement, or government-issued ID) - Copies of your **medical and prescription insurance cards** (front and back), even if you're uninsured - **Pharmacy statement** (if available) ### Step 2: Complete the Patient Application Form Download the "Patient Application" form from the Bausch Health PAP website. The form is available as an interactive PDF that you can fill out on your computer or print and complete by hand. Complete all sections on pages 1-3: - Patient Information (name, address, contact details) - Insurance Information - Patient Authorization and Certification (read carefully and sign) ### Step 3: Have Your Doctor Complete the Prescriber Section Give your healthcare provider pages 4-6 of the application form. Your doctor must: - Verify the prescription for Noritate - Complete the clinical information section - Sign the Prescriber Certification - Use original signatures (stamped signatures are not accepted for controlled substances) ### Step 4: Attach Supporting Documents Include copies of: - Front and back of your medical insurance card - Front and back of your prescription insurance card - Pharmacy statement (if provided) - Proof of income - Proof of residency **Important:** If required documents are missing, your application will be put on hold until all information is received. ### Step 5: Submit Your Application Submit your completed application and all documents by: **Fax:** 844-705-0160 **Mail:** BAUSCH HEALTH PATIENT ASSISTANCE PROGRAM P.O. Box 991624 Louisville, KY 40269 **Phone for Questions:** 833-862-8727 (8 AM to 5 PM ET) ## Timeline and What to Expect Once you submit your application: - All applications are reviewed on a **case-by-case basis** - There is **no cost to apply** - Processing time varies; the program will contact you once a decision is made - If approved, you are eligible to receive Noritate **at no cost for up to 12 months** from your approval date - Your medication will be **shipped directly to you** ## Reauthorization and Renewal If you are approved for the program: - Your assistance is valid for **12 months from the approval date** - The program will **reconfirm your income and insurance eligibility annually** - If you have a **change in insurance status or income**, you may become ineligible - **Medicare Part D enrollees** must reapply each year; all Medicare Part D patients are terminated on December 31 - You may reapply to the program annually if you continue to meet eligibility requirements and have a valid prescription ## What If Your Application Is Denied? If your application is denied, you have several options: - **Appeal:** Contact the program at 833-862-8727 to understand the reason for denial and explore appeal options - **Reapply:** If your circumstances change (income decreases, insurance coverage ends), you may reapply - **Alternative Assistance:** Ask your doctor about other patient assistance programs, generic alternatives, or community health resources - **Medicaid:** If you qualify for Medicaid, there is a separate application form specifically for Medicaid-only patients ## Important Reminders - This program is designed for **outpatients only**; if you are hospitalized or in a facility, you may not be eligible - You must have a **valid prescription** from a licensed U.S. healthcare professional - Income and insurance eligibility are verified; providing false information may result in program termination - If your circumstances change, notify the program immediately - This program does not cover inpatient medications or treatments ## Disclaimer This guide provides general information about the Bausch Health Patient Assistance Program as of March 2026. Program eligibility requirements, income thresholds, and procedures are subject to change. For the most current and complete information, visit BauschHealthPAP.com or call 833-862-8727. Always consult with your healthcare provider about your treatment options and medication needs. This guide is not a substitute for official program documentation or professional medical advice.

Program information last verified: March 30, 2026