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Welcome to the Allergan BOTOX® Reimbursement Solutions Website

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PRESCRIBING INFORMATION


CONTACT US

Phone Number (800) 44-BOTOX, Option 4
   
Fax Number (877) 530-6680

Monday through Friday
9:00am- 8:00pm ET
Address
Botox®
PO Box 1370
San Bruno, CA 94066

Your Provider Resource Center for Service and Information Relating to BOTOX® Reimbursement
Click here to see Important Information about Botox (onabotulinumtoxinA)

BOTOX PATIENT ASSISTANCE® Program Support

The program provides BOTOX® at no charge to financially eligible patients. Those who may qualify include patients who are uninsured or underinsured. Allergan is proud to assist eligible uninsured and underinsured patients with their treatment through the donation of BOTOX®vials.


Facts About Program

Program Application
Download  a BOTOX PATIENT ASSISTANCE® Program Application

Eligibility

To receive help from the program you must:

    • Be uninsured or underinsured
    • Have income less than or equal to 500% of the Federal Poverty Level
    • Be a resident of the United States or Puerto Rico

Who May Apply

The BOTOX PATIENT ASSISTANCE® Program is dedicated to helping financially eligible patients.  There are certain financial and other requirements that you must meet to qualify for the program.  You may qualify if:

    • You do not have insurance
    • Your insurance is not sufficient to meet your medical needs

How to Apply

With help from our step-by-step guide, applying for the program is simple. Just follow the steps below to find out the process for the program.

    • Call our hotline at (800) 44-BOTOX, Option 4. A Reimbursement Counselor can help answer any questions and send you an application. Or click the button above to download an application now.
    • Return the completed application and supporting documents to the program.
    • Once received, we will review the information and send a Notification Letter and Product Request Form so you can begin your BOTOX® treatment.

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The information on this site is intended for US healthcare providers only.
No information in this site is provided with the intention to give medical advice or instructions on the accurate use of Allergan products.
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