Eligible patients may pay as little as $15 for a 30‑ or 90‑day fill.*

Sample Request

Request samples for your office today.

Prior Authorization Support

Online tools to help prescribers navigate the PA and medical necessity process.

*Maximum savings limit applies; patient out-of-pocket expense may vary. Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare program. See Program Terms, Conditions, and Eligibility Criteria at

Contact Allergan Medical Information toll-free at 1-800-678-1605.