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Commonly Asked Questions about Botox patient assistance program Application Forms

Once we receive all the information needed, we usually review applications within two business days. After that, well contact you and your health care provider to let you know if you qualify.
If approved for myAbbVie Assist Patient Assistance, we will send the BOTOX Request Form to the Prescriber to order the medication. Prior to each subsequent shipment, the Prescriber must complete the BOTOX Request Form and schedule the next delivery. B-APP1-23F-1A June 2023 THIS PAGE IS FOR REFERENCE ONLY.
Yes, the BOTOX Savings Program helps eligible patients save on out-of-pocket costs related to both BOTOX medicine and/or related procedure not covered by insurance. These costs are sometimes billed separately from one another. The BOTOX Savings Program does not provide help for office visit co-pay costs.
The BOTOX Savings Program helps eligible patients receive money back on any co-pay, co-insurance, or deductible costs associated with their BOTOX procedure. Terms and conditions apply.