Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
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Updated May 11, 2015
 

Levaquin

Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program

This program provides brand name medications at no or low cost.

Provided by: Johnson & Johnson Patient Assistance Foundation, Inc.

PO Box 221857
Charlotte, NC 28222-1857

TEL: 800-652-6227


ALT PHONE: 800-523-5870
FAX: 888-526-5168
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Johnson & Johnson Patient Assistance Foundation, Inc.-Patient Application

HIV Common Application; Johnson & Johnson (EDURANT, INTELENCE, PREZISTA)

 

Medications

  • Levaquin Oral Solution 250mg/10mL (levofloxacin)
  • Levaquin Tablet 250mg, 500mg, 750mg (levofloxacin)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? *See Additional Information Section Below
Income Varies. **See below for details
Diagnosis/Medical Criteria Not applicable
US Residency Required? Must reside permanently in the US or US territories
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Doctor's office or patient is sent card to be used at pharmacy
Delivery Time Varies
Refill Process Varies per medication
Limit Varies
Re-application New application, new documentation yearly
   

Additional Information

*Some Medicare Part D patients who cannot afford their medicines, and who meet certain financial criteria, may also be eligible for assistance. Please Contact the program for more information (1-800-652-6227).

**Please call 1-800-652-6227 or visit Program website for specific FPL income requirements.


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2. Updated May 12, 2015
 

Levaquin

Johnson & Johnson Patient Assistance Foundation, Inc. Hospital Access Patient Assistance Program

This program provides medication at no cost.

Provided by: Johnson & Johnson Patient Assistance Foundation, Inc.

PO Box 220455
Charlotte, NC 28222-0455

TEL: 800-652-6227


FAX: 800-521-2437
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Johnson & Johnson Hospital Access Patient Assistance Program Application

 

Medications

  • Levaquin Tablet dosage varies (levofloxacin)
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? Not specified
Income Based on FPL
Diagnosis/Medical Criteria Not applicable
US Residency Required? Must be residing in the US or US territory
   

Application

Obtaining Representative from the hospital must call for an application or download it from the website
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
Doctor's Action Hospital must complete product request form for each replacement
Applicant's Action Not specified
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Hospital
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

This program allows eligible hospitals to receive free medications to give to qualified outpatients directly.

Contact the program for more details (1-800-652-6227).