Bausch Health understands that some patients may face financial obstacles that can keep them from obtaining the prescription products they need. Bausch Health is committed to improving access to medications through our Compassionate Use Program.

Bausch Health, Canada (BHC) Compassionate Use Program (CUP)

PROGRAM ELIGIBILITY:

  • Patient must be a Canadian resident.
  • Patient cannot have or qualify for any private or government prescription coverage for the prescribed product.
  • The patient monthly household income must be within the CUP eligibility level. This level is established at the sole discretion of BHC.

INSTRUCTIONS:

  • The Patient Information Section must be filled out completely and signed by the patient.
  • The Physician Section must be filled out completely and signed by the physician.
  • Incomplete applications will not be processed and will be returned to the Physician for completion.
  • An original prescription to a maximum of three (3) month course must accompany the application.
  • Please allow at least two-three (2-3) weeks for processing and for delivery of medication to the Physician’s office for approved applications.
  • It is the responsibility of the Physician to contact BHC a few weeks prior to the patient requiring further medication. A separate application must be submitted by the Physician for each request of medication from the CUP, even to receive a refill of a medication previously provided. In this case, the physician must document the patient’s clinical improvements after 3 months of treatment with the medication. If the Physician is making an application for a refill for the patient, please submit the application in advance so that the patient can continue with his/her medication.

Access the application form.