Besivance Patient Assistance Program
Besivance (besifloxacin ophthalmic suspension) is a prescription ophthalmic antibiotic suspension manufactured by Bausch + Lomb. An approximate retail cost for one 5 mL bottle (0.6%) of brand-name Besivance is $290–$350 before insurance or discounts. Actual pharmacy prices may be lower or higher.
Eligible patients may be able to receive Besivance at little or no cost through an appropriate Patient Assistance Program. Patient Help Network helps patients prepare and submit applications to programs for which they may qualify.
How Prescription Details Affect Besivance Assistance Eligibility
About Patient Assistance for Besivance
Patient Assistance Programs may help eligible patients who cannot afford their prescribed medication.
Patient Help Network assists with the application process by helping collect required information, coordinating documents with the prescribing healthcare provider, preparing the application, and following its status after submission.
Each program establishes its own requirements and makes all final eligibility decisions. Approval is not guaranteed.
About Besivance
Besivance is the brand name for besifloxacin ophthalmic suspension, a prescription antibiotic eye drop manufactured by Bausch + Lomb. It is indicated for the treatment of bacterial conjunctivitis caused by susceptible bacteria.
- Brand name: Besivance
- Generic name: besifloxacin ophthalmic suspension
- Manufacturer: Bausch + Lomb
- Estimated retail cost: Approximately $290–$350 for one 5 mL bottle (0.6%)
- Prescription required: Yes
- Patient assistance: May be available to eligible patients
Patients who have been prescribed Besivance and are unable to afford it may be able to apply to an appropriate Patient Assistance Program. Each program determines eligibility and makes the final approval decision.
For questions about the use, dosing, or safety of Besivance, patients should speak with their prescribing healthcare provider.
Step 1 – Submit Application
Provide basic prescription and household information to begin the application process.
Step 2 – Application Review
Information is reviewed and submitted to appropriate Patient Assistance Programs.
Step 3 – Program Decision
Final eligibility decisions are made by each program. Additional steps or renewals may be required.
PHN will contact you within 24 hours to discuss your situation and help identify appropriate next steps for the application process.
General Eligibility Guidelines
Patient Assistance Programs consider several factors when reviewing an application. General preliminary requirements may include:
- A current prescription for Besivance
- Treatment by a licensed healthcare provider
- U.S. residency
- Limited or insufficient prescription coverage
- Household income or financial need within the program’s guidelines
- Patient and prescriber information required for the application
Requirements vary by program. Each program applies its current requirements and makes the final eligibility decision.
Frequently Asked Questions
Eligible patients approved by an appropriate Patient Assistance Program may receive Besivance at little or no cost. Approval is not guaranteed.
An approximate retail cost for one 5 mL bottle (0.6%) of brand-name Besivance is $290–$350 before insurance or discounts. Actual pharmacy prices may be lower or higher. These rounded figures are illustrative retail estimates, not guaranteed quotes. Other strengths, forms, or quantities may cost differently. Pricing reference checked September 2026. This is the medication cost, not a PHN service fee.
Applicants generally provide information about their prescription, household income, insurance coverage, and prescribing healthcare provider. Additional documents may be requested.
Patient Help Network helps prepare the application, coordinate required information, submit completed documents, and follow the application status.
The receiving Patient Assistance Program reviews the application and makes the final decision. Patient Help Network cannot guarantee approval.
