Prescription Medication Assistance

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 


Eligible Medications: Xalatan

 Medication Assistance Program Instructions

Pfizer Medication Assistance Application


Eligible Medications: Betoptic-S, Travatan, Timolol, Azopt, Brimonidine, Pilocarpine

 Medication Assistance Program Instructions

Alcon Medication Assistance Application


Eligible Medications: Alphagan P, Lumigan, Combigan, Restasis

 Medication Assistance Program Instructions

Allergan Medication Assistance Application


Eligible Medications: Cosopt, Trusopt

 Medication Assistance Program Instructions

Merck Medication Assistance Application


If you have any further questions,

please call the office at (804) 217-6363