Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Topamax

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

 

Program Applications and Forms

Johnson & Johnson Hospital Access Patient Assistance Program Application

 

Medications

  • Topamax tablet (topiramate)
 

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 New application, new documentation yearly
   

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).


Updated August 01, 2017


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

Rx Outreach Medications

This program provides medication at low cost. (Most brand names are provided for reference purposes only)

Provided by: Rx Outreach

PO Box 66536
St. Louis, MO 63166-6536

TEL: 888-796-1234


FAX: 800-875-6591
Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Rx Outreach Application

Rx Outreach Diabetic Supplies Order Form (Prodigy)

Rx Outreach Refills and New Prescription Form

Rx Outreach Medication List

 

Medications

  • Topamax (topiramate) 
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must reside in the US
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax or E-Prescribe online
Doctor's Action Give prescription to patient
Applicant's Action Complete section and sign
Decision Communicated Medications sent if accepted. If denied patient and doctor notified
Decision Timeframe Usually same day
   

Medication

Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit Only limited by manufacturer's guidelines
Re-application New application yearly
   

Additional Information

Some medications are available for a fee of $20 for up to a 180 day supply.
Check the Rx Outreach website for the exact price and most current medication list.

Contact Program for Spanish Application(s)/Form(s).


Updated June 27, 2017