Xipere

Indicated For

Diabetic macular edema, uveitis

About This Medication

# Bausch + Lomb Patient Assistance Program Guide: How to Get Xipere at Low or No Cost ## About This Program The Bausch + Lomb Patient Assistance Program is designed to help uninsured and underinsured patients access Xipere (triamcinolone acetonide suprachoroidal injection) at no cost. This program recognizes that affording prescription medications can be challenging, and it exists to ensure that financial barriers don't prevent you from receiving the treatment your doctor has prescribed. ## About Xipere Xipere is a suprachoroidal injection of triamcinolone acetonide used to treat certain eye conditions. Your ophthalmologist has determined that this medication is the right treatment for your condition. The Bausch + Lomb Patient Assistance Program helps make this medication accessible regardless of your financial situation. ## Who Qualifies for This Program? You may be eligible for the Bausch + Lomb Patient Assistance Program if you meet all of the following criteria: - You are a legal United States resident - You have a valid prescription from a licensed U.S. healthcare professional for Xipere - You do not have insurance coverage for Xipere, or your insurance does not cover this medication - You are being treated as an outpatient (not hospitalized) - You meet the program's pre-defined eligibility requirements **Special Note for Medicaid Patients:** If you are on Medicaid and your plan stopped covering Bausch Health medications as of October 1, 2025, you may be eligible to receive Xipere for free through this program. ## Income Eligibility The Bausch + Lomb Patient Assistance Program reviews all applications on a case-by-case basis. While specific income thresholds are not publicly listed, the program considers your total annual household income as part of the eligibility determination. This means the program takes into account your financial situation comprehensively rather than applying a rigid cutoff. When you apply, be prepared to provide information about your household income. The program uses this information to determine whether you qualify for free medication. ## Insurance Requirements To qualify for this program, you must not have insurance coverage for Xipere. This includes: - No active health insurance that covers this medication - Insurance that specifically excludes Xipere from coverage - Medicaid plans that stopped covering this medication If you have insurance that covers Xipere, you would typically use that coverage first. However, if your insurance denies coverage or you have other barriers to access, contact the program directly at 1-833-862-8727 to discuss your situation. ## How to Apply: Step-by-Step Instructions ### Step 1: Gather Required Documents Before starting your application, collect the following: - Your enrollment form (available from the program) - A copy of your medical insurance card (front and back) - A copy of your prescription insurance card (front and back) - Your valid prescription for Xipere from your ophthalmologist - Information about your household income ### Step 2: Complete Your Application You have two options for submitting your application: **Option A: Apply by Phone** Call 1-833-862-8727, Monday-Friday, 8am-8pm EST. A program representative will guide you through the application process over the phone. There is no cost to apply. **Option B: Apply by Mail or Fax** Complete the enrollment form and mail or fax it along with copies of your insurance cards to: Fax: 844-705-0160 Mail: BAUSCH HEALTH PATIENT ASSISTANCE PROGRAM P.O. Box 991624 Louisville, KY 40269 ### Step 3: Submit Required Documentation Make sure to include: - Completed enrollment form with your signature - Copies of both sides of your medical and prescription insurance cards - Your valid prescription for Xipere - Any other documentation requested by the program **Important:** If any required information is missing, your application will be put on hold until all documents are received. Make sure everything is complete before submitting. ### Step 4: Wait for Approval The program will review your application and notify you of the decision. Applications may be approved in as little as 24-48 hours. Your information is kept secure and confidential throughout this process. ## Timeline and Medication Delivery Once your application is approved, your free Xipere will be shipped directly to your home. There are no copays or shipping fees. You can receive medication through this program for up to 1 year. After that time, if you remain eligible and have a valid prescription, you may be able to reapply to the program annually. ## What If Your Application Is Denied? If your application is denied, you have several options: 1. **Request clarification:** Contact the program at 1-833-862-8727 to understand why your application was not approved. 2. **Reapply:** If your circumstances have changed (such as a change in income or insurance status), you may be able to reapply. 3. **Explore other options:** Ask your ophthalmologist about: - Other treatment options that may be covered by your insurance - Other patient assistance programs - Clinical trials - Hospital or clinic financial assistance programs 4. **Contact patient advocacy organizations:** Organizations focused on eye health may have additional resources or information about accessing medications. ## Reauthorization and Refills Your assistance through this program lasts for up to 1 year. Before your year of assistance ends, you should: 1. Contact the program to discuss your continued need for Xipere 2. Obtain a new prescription from your ophthalmologist if you still need the medication 3. Reapply to the program if you remain eligible The program will review your new application using the same eligibility criteria. If you continue to meet the requirements, you may receive another year of free medication. ## Important Disclaimer This guide provides general information about the Bausch + Lomb Patient Assistance Program. Program details, eligibility requirements, and procedures may change. For the most current and complete information, contact the program directly at 1-833-862-8727 or visit the official program website. This program is not insurance and does not replace your health insurance coverage. Always work with your ophthalmologist and healthcare team to determine the best treatment plan for your eye condition. ## Contact Information **Phone:** 1-833-862-8727 Monday-Friday, 8am-8pm EST **Fax:** 844-705-0160 **Mailing Address:** BAUSCH HEALTH PATIENT ASSISTANCE PROGRAM P.O. Box 991624 Louisville, KY 40269 **Cost to Apply:** Free—there is no charge to submit an application.

Program information last verified: March 30, 2026