Zirgan Patient Assistance Program
Zirgan (ganciclovir ophthalmic gel 0.15%) is a prescription ophthalmic antiviral distributed by Bausch & Lomb Americas Inc.. An approximate retail cost for one 5 g tube (0.15%) of brand-name Zirgan is $530–$650 before insurance or discounts. Actual pharmacy prices may be lower or higher.
Eligible patients may be able to receive Zirgan 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 Zirgan Assistance Eligibility
About Patient Assistance for Zirgan
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 Zirgan
Zirgan is the brand name for ganciclovir ophthalmic gel 0.15%, a prescription ophthalmic antiviral distributed by Bausch & Lomb Americas Inc.. It is used to treat acute herpetic keratitis (dendritic ulcers) and is available only with a prescription from a licensed healthcare provider.
- Brand name: Zirgan
- Generic name: ganciclovir ophthalmic gel 0.15%
- Distributor: Bausch & Lomb Americas Inc.
- Estimated retail cost: Approximately $530–$650 for one 5 g tube (0.15%)
- Prescription required: Yes
- Patient assistance: May be available to eligible patients
Patients who have been prescribed Zirgan 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 Zirgan, 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 Zirgan
- Treatment by a licensed healthcare provider
- U.S. residency
- Limited or insufficient prescription coverage
- Financial need based on household income
- Required information from the patient and prescribing healthcare provider
Requirements vary by program and may change. Each program applies its current requirements and makes every final eligibility decision. Approval is not guaranteed.
Frequently Asked Questions
Eligible patients approved by an appropriate Patient Assistance Program may receive Zirgan at little or no cost. Approval is not guaranteed.
An approximate retail cost for one 5 g tube (0.15%) of brand-name Zirgan is $530–$650 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.
