Program

Program 1 of 3 Scroll down to see them all.

This program provides brand name medications at no or low cost.
Pharmaceutical Company	Johnson & Johnson Patient Assistance Foundation, Inc
Program Name	Johnson & Johnson Hospital Access Patient Assistance Program
Program Address	PO Box 220455 Charlotte, NC 28222-0455
Phone Number	800-652-6227
Fax Number	800-521-2437
Medications on Program	Ultracet Tablets (acetaminophen/tramadol)
Application Forms	Hospital Access Patient Assistance Program
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	The patient must meet insurance guidelines that are not disclosed and meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. This program is intended to provide qualified patients 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.
Application Process	Someone from the hospital must call for an application.
Application Requirements	Someone from the hospital must fill out a product request form for each replacement.
Program Details	The amount requested is sent to the hospital.
Last Updated	November 12, 2009

Program 2 of 3 Scroll down to see them all.

This program provides brand name medications at no or low cost.
Pharmaceutical Company	Johnson & Johnson Patient Assistance Foundation, Inc
Program Name	Johnson & Johnson Patient Assistance Program
Program Address	PO Box 221857 Charlotte, NC 28222-1857
Phone Number	800-652-6227, opt 1
Fax Number	888-526-5168
Medications on Program	Ultracet Tablets 37.5mg (acetaminophen/tramadol)
Application Forms	Johnson & Johnson Patient Assistance Program
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. This programs helps qualified patients gain access to medications donated by the operating companies of Johnson & Johnson. Medicare LIS (Low Income Subsidy) eligible patients are not eligible to receive assistance through this program. Patients receiving benefits under a Medicare Part D prescription drug plan are not eligible to receive assistance through this program, however program eligibility exceptions for Medicare Part D enrollees based on significant financial or medical need will be considered.
Application Process	With the patient's permission, anyone concerned can call for an application. The application will be faxed out. The completed application can be faxed or mailed back. Both the patient and doctor are notified in writing of acceptance or denial.
Application Requirements	The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.
Program Details	The medications are either sent to the doctor's office or the patient is sent a pharmacy card. The company automatically sends out refills. Once a year a new application with financial documentation is needed.
Last Updated	November 13, 2009

Program 3 of 3.

This is a discount card program.
Pharmaceutical Company	Together Rx Access
Program Name	Together Rx Access
Program Address	PO Box 9426 Wilmington, DE 19809-9944
Phone Number	800-444-4106
Fax Number
Medications on Program	Ultracet Tablets 37.5mg (acetaminophen/tramadol)
Application Forms	Together Rx Access
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	The patient must have no prescription coverage for any medications and have an income at or below $45000 if single, $60000 for a family of 2, $75000 for a family of 3, $90000 for a family of 4, $105000 for a family of 5 Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. The patient must not be eligible for Medicare. Most cardholders save between 25%-40% on brand name prescription medications. Each card holder's savings depend on such factors as the particular drug purchased, amount purchased, and the pharmacy where purchased.
Application Process	The patient can call to get an application, apply on line, or download the application.
Application Requirements	Not applicable.
Program Details	The patient is sent a Together Rx Access prescription savings card.
Last Updated	July 31, 2009