Allergan Patient Assistance Program - ALPHAGAN® P, COMBIGAN®, ESTRACE®, LUMIGAN® 0.01%, NAMENDA®, RESTASIS®, VRAYLAR

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For Medicare recipients, we will review your qualifying financial need based on a combination of your insurance coverage, household income, and out-of-pocket medical expenses during the application process. To help you understand the income guidelines that we use to evaluate qualifying financial need, we’ve provided the table below:

Household size Annual income

1 $77,280 or less

2 $104,520 or less

3 $131,760 or less

4 $159,000 or less