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

Procrit for Injection 1 (epoetin alfa)

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

Procrit Injection  (epoetin alfa)

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 March 25, 2013 Back | Print Page

This is a copay assistance program.

Diplomat's Co-Pay Assistance Navigator Program

Provided by:


Diplomat Specialty Pharmacy
4100 S Saginaw St.
Flint, MI 48507

TEL: 877-977-9118 ext. 89864


ALT PHONE:
FAX: 810-282-0176
 Program Website

Languages Spoken: English

Patient assistance
applications


 

Medications

Procrit Solution for Injection 2000units/ml, 3000units/ml, 10000units/ml, 20000units/ml, 40000units/ml (epoetin alfa)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Determined case by case
Those with Part D Eligible? Yes
Income Determined case by case
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Yes
Obtaining Call or complete online
Receiving Faxed, mailed or complete online
Returning Mail or fax
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section, sign and provide annual income information. Proof of income may be request by program at any time
Decision Communicated Patient and/or Doctor are notified
Decision Timeframe Within 1-2 business days
Amount/Supply Amount requested is sent
Sent To Patient's home
Delivery Time Once approved; within 2 business days
Refill Process Company contacts patient to arrange
Limit Varies per medication
Re-application Determined case by case

Additional Information:

Diplomat Specialty Pharmacy is a full service pharmacy that can help patients seek funding assistance for the co-pay portion of their required medications. Applications can be completed online or Prescription, Demographics and Proof of Income may be faxed to 810-282-0176 Attn: Dorrie 



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