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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Xarelto

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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 42796
Cincinnati, OH 45242

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: Contact program

 

Medications

  • Xarelto tablet (rivaroxaban)
 

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 Enroll online
Receiving Must apply online
Returning Must apply online
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 November 29, 2018


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

Xarelto

View Coupon View Coupon

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

This program provides brand name medications at no or low cost

Provided by: Johnson & Johnson Patient Assistance Foundation, Inc.

PO Box 42796
Cincinnati, OH 45242

TEL: 800-652-6227


FAX: 888-526-5168
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Johnson & Johnson Patient Assistance Foundation, Inc. Patient Application

HIV Common Application: Johnson & Johnson Patient Assistance Foundation, Inc.

 

Medications

  • Xarelto (rivaroxaban)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? *See Additional Information Section Below
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 a copy of proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Not specified
   

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

*Some Medicare Part D patients who cannot afford their medicines, and who meet certain financial criteria, may also be eligible for assistance. Please Contact the program for more information (1-800-652-6227).

**Please call 1-800-652-6227 or visit Program website for specific FPL income requirements.


Updated November 30, 2018