Enroll: Patient Eligibility

Are you 18 years or older?

Yes

Are your prescriptions reimbursed (in whole or in part) under any federal, state, or other governmental programs? Government-sponsored plans include Medicare (Medicare Advantage Part A, B, and D), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, and any other federal or state healthcare program.

Yes

We’re sorry. Based on your response, you’re not eligible for the SILIQ Solutions^™ Instant Savings Program.

VISIT SILIQ.COM FOR MORE INFORMATION

See Eligibility Criteria and Terms and Conditions below.

Please fill out the form below to complete your enrollment. All fields are required.

First Name

Please enter a first name.

Last Name

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Date of Birth

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Please enter a valid email address.

Mobile Phone

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Zip Code

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I would like to receive additional communications (health tips, wellness tools, coupons, other discounts, educational materials, product information, etc) from Bausch Health and its affiliates.

By clicking “SUBMIT,” you confirm that you read and understand the Eligibility Criteria, Terms and Conditions, Privacy Policy, and Legal Notice of the program and that you currently meet all eligibility criteria and will comply with the Terms and Conditions of the savings program.

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Instant SavingsProgram

If eligible, you may pay as little as

Enroll: Patient Eligibility

Please fill out the form below to complete your enrollment. All fields are required.

Instant Savings
Program