Vyzulta

Indicated For

open-angle glaucoma, ocular hypertension

About This Medication

# Bausch Health Patient Assistance Program Patient Guide: How to Get Vyzulta at Low or No Cost **Vyzulta (latanoprostene bunod ophthalmic solution, 0.024%)** is a prescription eye drop used to lower intraocular pressure in patients with open-angle glaucoma or ocular hypertension. It works by increasing the outflow of fluid from the eye, helping to prevent vision loss from elevated eye pressure.[1][2] This guide explains the **Bausch Health Patient Assistance Program (PAP)**, which provides **Vyzulta at no cost** to eligible patients who meet specific income and insurance criteria. The program helps uninsured or underinsured individuals access this important medication without financial burden. ## Who Qualifies for the Program? Eligibility is determined on a **case-by-case basis**. You may qualify if you meet **all** of these requirements: - **Legal U.S. resident** (including Puerto Rico; not available if residing in a hospital, nursing home, correctional facility, or court-appointed program).[1][2] - **Valid prescription** for Vyzulta from a licensed U.S. healthcare professional.[1][2] - **Outpatient treatment** (not inpatient).[1][2] - **Household income at or below 300% of the Federal Poverty Level (FPL)**, based on household size. Use the current FPL guidelines from the U.S. Department of Health and Human Services to check (available at aspe.hhs.gov/poverty-guidelines).[2] - **Limited or no insurance coverage** for Vyzulta: - Uninsured for the product.[1][2] - Denied coverage by commercial insurance (after exhausting appeals).[2] - No coverage through government programs like Medicare Part D, Medicaid, Medigap, VA, DoD, TRICARE, or other federal/state pharmacy assistance (Medicare Part D patients may appeal case-by-case).[2] - Your prescriber must not be excluded from federal healthcare programs.[2] **Medicaid patients**: Use the separate "Application for Medicaid-Only Patients" form. As of changes after October 1, 2025, Medicaid patients may qualify for free medication.[1][4] **Income Eligibility Breakdown** The program caps income at **300% FPL**. Here's a table with approximate 2026 guidelines for common household sizes (exact figures update annually; verify current FPL): | Household Size | 100% FPL | 300% FPL Threshold | |----------------|----------|---------------------| | 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 for 100% FPL, then multiply by 3 for 300%.* Income includes all household sources; proof required.[2] ## Insurance Requirements The program targets those with **limited or no coverage** for Vyzulta. **Discount cards do not count as coverage**.[2] - **Uninsured**: Fully eligible if other criteria met.[2] - **Commercial insurance**: Must be denied coverage and exhaust appeals.[2] - **Medicare Part D**: Generally ineligible, but appeals reviewed case-by-case. All Part D enrollees terminate December 31 and must reapply.[2] - **Medicaid**: Separate application; may qualify post-2025 changes.[1][4] Provide **insurance cards (front/back)** and proof of denial if applicable. Applications missing this go on hold.[1] ## Step-by-Step Application Process Applications are **free** and reviewed individually. Multiple methods available.[1][3] 1. **Check eligibility**: Confirm residency, prescription, income, and insurance status.[2] 2. **Download forms**: Visit BauschHealthPAP.com. Use standard form or Medicaid-only if applicable.[1][4] 3. **Complete patient sections**: Fill Patient Information, Insurance Information, and sign Authorization/Certification (pages 2-3).[1] 4. **Prescriber completes**: Doctor fills pages 4-6, signs certification (docu-sign OK; no stamps for controlled substances, though Vyzulta isn't).[1] 5. **Gather documents**: - Proof of income (e.g., tax returns, pay stubs). - Proof of residency (e.g., utility bill). - Prescription. - Insurance cards (front/back); pharmacy statement if no card.[1] 6. **Submit**: - **Phone**: Call (833) 862-8727 for assistance.[provided] - **Fax**: 844-705-0160.[1][3] - **Mail**: Bausch Health Patient Assistance Program, P.O. Box 991624, Louisville, KY 40269.[1][3] - Online option or printable forms after eligibility questions.[3] **Tip**: Asterisked (*) fields are mandatory; missing info holds processing.[1] ## Timeline and Delivery - **Processing**: Typically **24-48 hours** once complete, but allow more for reviews.[provided] - **Approval duration**: Up to **12 months** from approval date. Annual reconfirmation of income/insurance required.[2][provided] - **Delivery**: Shipped free to **your home or prescriber's office**.[provided] - **Refills**: **Reauthorization required** annually or upon changes. Reapply if insurance/income changes.[2][provided] **Medicare note**: Automatic termination December 31; reapply for new year.[2] ## Alternatives if Denied - **Appeal denial**: Contact program if you believe criteria unmet (e.g., Medicare appeals).[2] - **Other assistance**: Check RxAssist.org, NeedyMeds, or Partnership for Prescription Assistance for Vyzulta copay cards/savings (if insured).[4] - **Manufacturer copay programs**: Bausch may offer separate savings for commercially insured (not PAP).[3] - **Generic latanoprost**: Cheaper alternative for glaucoma; discuss with doctor. - **Patient support**: Call (833) 862-8727 for guidance.[provided] **No biosimilars** available for Vyzulta.[provided] ## Important Disclaimer This guide is for informational purposes based on program details as of 2026. **Bausch Health determines eligibility at its sole discretion**; criteria may change. Always verify at BauschHealthPAP.com or by phone. Not medical advice—consult your doctor. Program not for controlled substances requiring special handling. Income thresholds use current FPL; household defined by tax dependents. Bausch Health reserves rights to modify/terminate.[1][2] (Word count: 1028)

Program information last verified: March 30, 2026