| 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. |
|||
Xarelto |
View Coupon |
||
Johnson & Johnson Patient Assistance Foundation, Inc. Hospital Access Patient Assistance ProgramThis program provides medication at no cost. |
|||
Provided by: Johnson & Johnson Patient Assistance Foundation, Inc. |
|||
TEL: 800-652-6227 |
Languages Spoken:
English |
||
Program Applications and Forms |
|||
Johnson & Johnson Hospital Access Patient Assistance Program Application: Contact program |
|||
Medications |
|||
|
|||
Eligibility Requirements |
|||
| Insurance Status | Contact program for details. | ||
| Those with Part D Eligible? | Not specified | ||
| Income | Not applicable | ||
| Diagnosis/Medical Criteria | Not applicable | ||
| US Residency Required? | Must be residing in the US or US territory | ||
Application |
|||
| Obtaining | Enroll online | ||
| Receiving | Must apply online | ||
| Returning | Not applicable | ||
| 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). The hospital access application is only available via the online portal. |
|||
| Updated February 07, 2023 | |||
| 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. |
|||
Xarelto |
View Coupon |
||
Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance ProgramThis program provides medication at no cost. |
|||
Provided by: Johnson & Johnson Patient Assistance Foundation, Inc. |
|||
PO Box 0367 TEL: 800-652-6227FAX: 888-526-5168 |
Languages Spoken:
English, Spanish, Others By Translation Service |
||
Program Applications and Forms |
|||
Johnson & Johnson Patient Assistance Foundation, Inc. Patient Application |
|||
Johnson & Johnson Patient Assistance Foundation, Inc. Patient Application: Imbruvica |
|||
Medications |
|||
|
|||
|
|||
Eligibility Requirements |
|||
| Insurance Status | Contact program for details. | ||
| Those with Part D Eligible? | Contact program for details. | ||
| Income | Varies. *See below for details | ||
| Diagnosis/Medical Criteria | Medication must be for outpatient use only | ||
| 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 required documents | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | 3-5 business days | ||
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 |
|||
| *Please call (1-800-652-6227 or visit Program website for specific FPL income requirements. |
|||
| Updated February 07, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 3 of 3. | |||
Xarelto |
View Coupon |
||
Janssen Support ProgramThis program provides brand name medications at no or low cost |
|||
Provided by: Johnson & Johnson Health Care Systems Inc. (JJHCS) |
|||
TEL: 833-742-0791FAX: 833-512-0497 |
Languages Spoken:
English |
||
Program Applications and Forms |
|||
Janssen Support Program Patient Authorization |
|||
Janssen Support Program Patient Authorization (electronically sign) |
|||
Medications |
|||
|
|||
|
|||
Eligibility Requirements |
|||
| Insurance Status | Must have insurance | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Based on FPL | ||
| Diagnosis/Medical Criteria | FDA-approved diagnosis | ||
| US Residency Required? | Must reside permanently in the US or US territories | ||
Application |
|||
| Obtaining | Call, download or apply online | ||
| Receiving | Complete online, download from website or faxed. | ||
| Returning | Fax | ||
| Doctor's Action | Complete section, sign, attach required documents | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Varies | ||
Medication |
|||
| Amount/Supply | Varies | ||
| Sent To | Varies | ||
| Delivery Time | Varies | ||
| Refill Process | Varies per medication | ||
| Limit | Varies | ||
| Re-application | New application, new documentation yearly | ||
Additional Information |
|||
| This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. Contact program for details. |
|||
| Updated January 25, 2023 | |||
