Relistor

Indicated For

Opioid-Induced Constipation

About This Medication

# Bausch Health Patient Assistance Program Patient Guide: How to Get Relistor (methylnaltrexone bromide) at Low or No Cost Relistor (methylnaltrexone bromide) is a prescription medication used to treat opioid-induced constipation (OIC) in adults with chronic non-cancer pain or advanced illness who are receiving palliative care, when response to laxative therapy has not been sufficient. This guide explains how the **Bausch Health Patient Assistance Program (PAP)** can help eligible patients get Relistor at low or no cost if you face financial hardship and lack insurance coverage for the drug.[1][2] ## About Relistor **Relistor** is available as a subcutaneous injection or oral tablet. It works by blocking opioid receptors in the gut without affecting pain relief from opioids elsewhere in the body, helping to relieve constipation caused by opioid pain medications. It's typically prescribed for adults receiving opioids for at least 4 weeks who haven't responded well to standard laxatives. Common side effects include abdominal pain, diarrhea, nausea, and flatulence. Always follow your doctor's instructions and report side effects. This program provides free medication to qualified patients but does not cover medical advice—consult your healthcare provider for personalized guidance.[1] ## Who Qualifies for the Program? The Bausch Health PAP is designed for U.S. residents struggling to afford Bausch Health products like Relistor. To qualify, you generally must:[1][2] - Be a **legal U.S. resident** (Puerto Rico residents considered case-by-case). - Have a **valid prescription** from a licensed U.S. healthcare professional. - Lack **insurance coverage** for Relistor (Medicare Part D or other insurance handled case-by-case; Medicaid patients use a special form). - Be treated as an **outpatient** (not hospitalized). - Meet **predefined household income limits**, typically not exceeding **300% of the Federal Poverty Level (FPL)**. Income excludes alimony, child support, and food stamps. Exact thresholds aren't publicly listed and are verified case-by-case, often using credit reports from agencies like Experian Health.[1][2] All applications are reviewed individually at no cost to you.[1] ## Income Eligibility Breakdown Income limits are based on household size and **300% of the FPL**. Since specific figures aren't published, the program uses internal guidelines and may pull credit data to estimate your household size and income. Provide your total annual household income (excluding certain benefits) on the application. Here's a general table based on 2025 FPL guidelines (adjust for current year; confirm with program): | Household Size | 100% FPL (approx.) | 300% FPL Limit (approx.) | |----------------|--------------------|---------------------------| | 1 (Individual) | $15,060 | $45,180 | | 2 (Couple) | $20,440 | $61,320 | | 3 | $25,820 | $77,460 | | 4 | $31,200 | $93,600 | | +1 per member | +$5,380 | +$16,140 | *Notes: These are estimates; actual eligibility uses predefined limits. Check 'no income' box if applicable. Medicaid-eligible patients need proof of denial or non-coverage.[1][2] Contact the program for your situation.* ## Insurance Requirements You **must not have insurance coverage** for Relistor. Attach copies of your insurance cards (front/back) and a pharmacy statement showing your out-of-pocket (OOP) cost—without these, your application is incomplete.[1] - **Medicare Part D**: Case-by-case; if denied Low-Income Subsidy, attach denial letter. Approved Medicare patients get help through December 31 of the approval year.[1][2] - **Medicaid**: Use the special Medicaid-only application; must prove your plan doesn't cover Relistor.[3] - **Medicare Part C (Advantage)**: Disclose on form; impacts eligibility.[1] If insured but denied coverage for Relistor, you may still qualify.[1] ## Step-by-Step Application Process 1. **Verify Eligibility**: Call **(833) 862-8727** (8 AM-5 PM ET) or visit BauschHealthPAP.com to check basics.[1][2] 2. **Download Form**: Get the standard application (or Medicaid-only if applicable) from the website.[1][3] 3. **Patient Section**: Complete patient/insurance info on page 2, sign authorization on page 3, note pharmacy OOP cost, and check the box confirming attachment.[1] 4. **Prescriber Section**: Your doctor completes product selection (Relistor), prescription (page 5, with signature—e-sign OK, not stamped for controlled substances), and certification (page 6).[1] 5. **Gather Documents**: - Insurance cards (front/back). - Pharmacy statement with OOP cost. - Proof for Medicaid (denial/application). *No medical records needed.*[1] 6. **Submit**: Fax to **844-705-0160** or mail to **Bausch Health PAP, P.O. Box 991624, Louisville, KY 40269**. Online option available after eligibility questions.[1][2] Applications with missing *required* info go on hold.[1] ## Timeline and Delivery Processing time isn't specified but expect case-by-case review. Once approved, medication is **shipped to your provider or directly to you** free of charge. Re-enroll **annually**—program notifies you 60 days before expiration. Sign up for refills as needed.[1][2] ## Alternatives if Denied - **Appeal**: Contact (833) 862-8727 for reasons and next steps; provide requested info.[1] - **Other Programs**: Check NeedyMeds, RxAssist, or Partnership for Prescription Assistance for Relistor alternatives. - **State Programs**: Explore state pharmaceutical aid or generic laxatives. - **Financial Aid**: Patient Access Network (PAN) Foundation or HealthWell for OIC. - **Doctor Discussion**: Ask about samples, lower-cost options, or payment plans.[2] ## Disclaimer This guide is for informational purposes based on publicly available program details as of 2025. Eligibility, rules, and forms can change—always verify with Bausch Health PAP at (833) 862-8727 or BauschHealthPAP.com. We're not affiliated with Bausch Health; consult your doctor or pharmacist. No guarantee of approval; individual results vary. Income estimates use FPL approximations—program makes final determination.[1][2]

Program information last verified: March 20, 2026