Welcome to the BOTOX® Chronic Migraine Patient Support Program
Allergan Inc., the makers of BOTOX®, are pleased to provide you with financial assistance towards your BOTOX® therapy for the treatment of Chronic Migraines.
This program will provide up to 20% coverage toward the cost of each BOTOX® treatment for a maximum of three treatments within a 12 month period.
This program is administered by STI Technologies Limited (“STI”), an independent third party company contracted by the program sponsor, Allergan Inc. (“Allergan”).
STI is responsible for the collection and storage of personal information. By agreeing to participate in this program, you authorize STI to collect and store this data.
Your personal information will remain confidential and private, and will not be shared with any third party, or the program sponsor. Anonymous patient
information may be shared with the program sponsor in order to improve and manage this program.
BOTOX® Card Activation
To activate your BOTOX® Patient Support card and attain financial assistance, please complete these three steps:
1. Activate Your Card: Take five minutes to complete the required enrollment process. Please note: You will need to enter the name of the doctor who will be
treating you with BOTOX® to complete the enrollment process. If you would like to be kept informed as future benefit programs become available, please provide
consent when activating your card.
Once you have completed the required steps, your BOTOX® patient support card will be activated and ready to use within two hours.
2. Present Your Card: Bring your card and your BOTOX® prescription to the pharmacy and present them to your pharmacist.
3. Keep Your Card: As this program will provide up to three treatments of BOTOX® within a 12-month period, please ensure you keep your card for all future
If you have questions or concerns please email firstname.lastname@example.org or call 1-877-790-1991