| 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. |
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Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance ProgramThis program provides medication at no cost. |
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Provided by: Johnson & Johnson Patient Assistance Foundation, Inc. |
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Patient Assistance Program TEL: 800-652-6227FAX: 888-526-5168 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Johnson & Johnson Patient Assistance Foundation, Inc. Patient Application
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Johnson & Johnson Patient Assistance Foundation, Inc. Patient Application: Imbruvica, Sirturo |
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Medications |
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Eligibility Requirements |
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| 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 |
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| 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 |
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| 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 |
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| *Please call (800) 652-6227 or visit Program website for specific FPL income requirements. |
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| Updated May 15, 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. |
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Janssen Support ProgramThis program provides brand name medications at no or low cost |
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Provided by: Johnson & Johnson Health Care Systems Inc. (JJHCS) |
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TEL: 833-742-0791FAX: 833-512-0497 |
Languages Spoken:
English |
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Program Applications and Forms |
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Janssen Support Program Patient Authorization
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Medications |
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Eligibility Requirements |
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| 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 |
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| 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 |
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| 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 |
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| This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. Contact program for details. |
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| Updated May 17, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 3 of 3. | |||
Patient Access Network Foundation (PAN)This is a copay assistance program |
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Provided by: Patient Access Network Foundation |
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TEL: 866-316-7263FAX: 866-316-7261 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Patient Access Network Foundation (PAN) Application: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | *See Additional Information section below | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Between 400-500% of FPL | ||
| Diagnosis/Medical Criteria | FDA Approved Diagnosis - See Program Website for Details | ||
| US Residency Required? | Must reside and receive treatment in US | ||
Application |
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| Obtaining | Call or complete online | ||
| Receiving | Complete online or by phone | ||
| Returning | Not applicable | ||
| Doctor's Action | Varies | ||
| Applicant's Action | Call for information or inform doctor that he/she is in need | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Within 48 hours | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Patient is sent savings card to be used at pharmacy | ||
| Delivery Time | Once approved; shipped same day | ||
| Refill Process | Patient presents voucher/card to pharmacy for each refill | ||
| Limit | None | ||
| Re-application | New application every 12 months | ||
Additional Information |
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| *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details. |
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| Updated May 30, 2023 | |||
