If you have no insurance coverage, no benefits for prescription medication or you are experiencing financial hardship, many pharmaceutical companies offer assistance programs. If you would like to apply for one of the patient assistance programs, please locate the medication that you were prescribed or the name pharmaceutical company from the list below. You will find instructions for applying, as well as a link to the online application.
Once you have completed the application, please mail it to:
Commonwealth Eye Care Associates
3855 Gaskins Road
Henrico, VA 23233
Pfizer
Eligible Medications: Xalatan
Medication Assistance Program Instructions
Pfizer Medication Assistance Application
Alcon
Eligible Medications: Betoptic-S, Travatan, Timolol, Azopt, Brimonidine, Pilocarpine
Medication Assistance Program Instructions
Alcon Medication Assistance Application
Allergan
Eligible Medications: Alphagan P, Lumigan, Combigan, Restasis
Medication Assistance Program Instructions
Allergan Medication Assistance Application
Merck
Eligible Medications: Cosopt, Trusopt
Medication Assistance Program Instructions
Merck Medication Assistance Application
