The Allergan Patient Assistance Program provides certain products to patients in the United States who are unable to afford the cost of their medication and who meet other eligibility requirements.

How to Apply

Please either download the application below (if available) or go to the program website for more information on how to apply. Once you fill out your application, send it to the address on the application. Remember not to send program applications to PPA.

Product(s) Covered by Program

  • A

    • Acuvail®
    • Aczone®
    • Alphagan® P
  • C

    • Combigan®
  • L

    • Lumigan®
  • P

    • Pred Forte®
  • R

    • Restasis®
  • T

    • Tazorac® Cream