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

Program 1 of 3   Scroll down to see them all.  Updated March 26, 2013 Back | Print Page

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

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

Provided by:


Johnson & Johnson Patient Assistance Foundation, Inc
PO Box 220455
Charlotte, NC 28222-0455

TEL: 800-652-6227


ALT PHONE:
FAX: 800-521-2437
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Levaquin Tablet  (levofloxacin)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Not specified
Those with Part D Eligible? No
Income Between 200-400% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Not specified
Obtaining Hospital must call
Receiving Pre-filled application will be sent to Doctor's office
Returning Mail or fax
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
Amount/Supply Not specified
Sent To Hospital
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified

Additional Information:

Patients receiving Procrit for dialysis are not eligible for this program. This program is intended to provide qualified outpatients access to medications through a qualified DSH or DRG-exempt Cancer Center. DSH facilities and DRG-exempt Cancer Centers are assessed for eligibility according to standardized criteria.

TRAMADOL NOT AVAILABLE IN THE HAPAP PROGRAM IN STATES WHERE IT HAS BEEN CLASSIFIED AS A CONTROLLED/SCHEDULED II
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 3   Scroll down to see them all.  Updated May 21, 2013 Back | Print Page

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

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

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
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

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

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Not specified
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Not specified
Amount/Supply Not specified
Sent To Doctor's office or patient is sent card to be used at pharmacy
Delivery Time Not specified
Refill Process Automatically sent out
Limit Not specified
Re-application New application, new documentation yearly

Additional Information:

Medicare LIS (Low Income Subsidy) eligible patients are not eligible to receive assistance through this program.

This Program participates in the CPAPA. This single common application allows uninsured HIV-positive individuals with low incomes to use one application to apply for multiple assistance programs.

IMPORTANT: Send completed CPAPA to the corresponding addresses listed for each company.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 3 of 3.  Updated January 14, 2013 Back | Print Page

This is a discount card program.

Together Rx Access

Provided by:


Together Rx Access, LLC
One Outlet Lane
Bald Eagle Court
Lock Haven, PA 17745

TEL: 800-444-4106


ALT PHONE:
FAX:
Program Website

Languages Spoken: English, Spanish

Patient assistance
applications

 

Medications

Levaquin Tablet 250mg, 500mg, 750mg (levofloxacin)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? No, must be ineligible
Income At or below $45,000 if single, $60,000 for family of 2, $75000 for 3, $90,000 for4, $105,000 for 5
Diagnosis/Medical Criteria Not specified
US Residency Required? Not specified
Obtaining Enroll online
Receiving Downloaded from website
Returning Mail
Doctor's Action Not applicable
Applicant's Action If eligible, respond to 4 questions to enroll
Decision Communicated Patient notified
Decision Timeframe Not applicable
Amount/Supply Not applicable
Sent To Patient sent savings card to be used at pharmacy
Delivery Time Not applicable
Refill Process Not applicable
Limit Not applicable
Re-application Not applicable

Additional Information:

The patient must not be eligible for Medicare. Most cardholders save between 25%-40% on brand name prescription medications.

Call for most recent medications as the list is subject to change.



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