Vyzulta

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):

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)