Syprine

Indicated For

Wilson's disease

About This Medication

# Bausch Health Patient Assistance Program Patient Guide: How to Get **Syprine (trientine)** at Low or No Cost **Syprine (trientine)** is a prescription medication used to treat Wilson's disease, a rare genetic disorder where the body accumulates too much copper, potentially damaging the liver, brain, and other organs. This guide explains how to apply for the **Bausch Health Patient Assistance Program (PAP)**, which provides **Syprine** at no cost to eligible patients who meet specific financial and insurance criteria. The program helps uninsured or underinsured U.S. residents access this vital treatment without financial burden.[1][2] ## Who Qualifies for the Program? Eligibility is determined on a **case-by-case basis**. To qualify, you must: - Be a **legal U.S. resident** (including Puerto Rico) and treated as an **outpatient** (not residing in a hospital, nursing home, correctional facility, or similar).[1][2] - Have a **valid prescription** from a licensed U.S. healthcare professional for **Syprine (trientine)**, a product covered by the Bausch Health PAP.[1][2] - Lack insurance coverage for **Syprine**, or have been denied coverage by commercial insurance after exhausting appeals, or have no coverage through government programs like Medicare Part D, Medicaid, VA, TRICARE, etc. Medicare Part D patients may appeal for review.[1][2] - Meet **household income limits**: Annual income must not exceed **300% of the Federal Poverty Level (FPL)** based on household size. Guidelines are available at https://aspe.hhs.gov/poverty-guidelines.[2] - Have a prescriber not excluded from federal healthcare programs.[2] **Important**: Medicaid patients should use a separate application. All applications are free, and Bausch Health makes the final decision.[1][2] ## About Syprine (trientine) **Syprine** is the brand name for trientine hydrochloride, an oral chelating agent that binds to excess copper in the body and promotes its excretion through urine. It's typically prescribed for patients with Wilson's disease who cannot tolerate penicillamine (another chelator). Common side effects include nausea, fatigue, and skin rashes; your doctor will monitor copper levels via blood and urine tests. Always follow your healthcare provider's dosing instructions, usually starting at 750-1250 mg daily in divided doses. This program ensures access for those who need it most.[1] ## Income Eligibility Breakdown Income eligibility is based on **total annual household income** not exceeding **300% of the FPL**. Exact dollar amounts vary yearly and by household size—check current guidelines for precision. Here's an approximate table based on standard FPL calculations (adjust for latest figures): | 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 | *Add ~$5,380 per additional person at 100% FPL.* Reviewed case-by-case; provide proof like tax returns.[2] ## Insurance Requirements You must have **no insurance coverage** for **Syprine**. This includes: - **Uninsured** patients. - Denied by commercial insurance (after appeals). - No coverage via Medicare Part D, Medicaid, Medigap, VA, DoD, TRICARE, or state programs.[2] Discount cards don't count as coverage. Attach copies of insurance cards (front/back) and pharmacy statements. Medicare patients: Appeal possible, but all terminated Dec 31 annually and must reapply.[1][2] ## Step-by-Step Application Process 1. **Download the form**: Get the application at https://www.bauschhealthpap.com/siteassets/pdf/docs/bhc-bhpap-application-all-other-patients.pdf.[1] 2. **Patient section**: Complete Patient Information, Insurance Information (page 2), and sign Patient Authorization/Certification (page 3).[1] 3. **Prescriber section**: Have your doctor complete pages 4-6, including diagnosis, prescription, and Prescriber Certification. **Electronic or handwritten signatures** required (no stamps for controlled substances).[1] 4. **Gather documents**: Valid prescription, insurance cards (front/back), proof of income if requested.[1] 5. **Submit**: Fax to **844-705-0160** or mail to **Bausch Health Patient Assistance Program, P.O. Box 991624, Louisville, KY 40269**. Call **(888) 607-7267** or **833-862-8727** (8 AM-5 PM ET) for help.[1][3] Applications with missing info (marked with *) are held until complete.[1] ## Timeline and Delivery Processing time varies as reviews are case-by-case; expect **several weeks**. Once approved, medication is **shipped directly to you** at no cost for up to **12 months**.[1][2][3] Reconfirm eligibility annually; changes in income/insurance may affect status. Medicare patients reapply post-Dec 31.[2] ## Alternatives if Denied - **Appeal** the decision or reapply with updated info.[2] - Explore other programs like **HealthWell Foundation** for Homocystinuria/Organic Acidemias (may cover Wilson's).[3] - Patient Access Network (PAN) Foundation or state assistance. - Generic trientine if available; discuss biosimilars (none listed here).[3] - Contact your doctor for samples or low-cost pharmacies. ## Disclaimer This guide is for informational purposes only and based on publicly available program details as of 2026. Eligibility, terms, and availability can change—verify with Bausch Health at (888) 607-7267 or BauschHealthPAP.com. Not medical advice; consult your healthcare provider. Bausch Health reserves discretion in approvals.[1][2]

Program information last verified: March 30, 2026