Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 4.
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Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program

This program provides medication at no cost.

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

PO Box 0367
Chesterfield, MO 63006

TEL: 800-652-6227


FAX: 888-526-5168
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Johnson & Johnson Patient Assistance Foundation, Inc. Patient Application

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

 

Medications

  • apalutamide tablet (Erleada) Tablet
 

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 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

*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 October 03, 2022


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 4.
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Janssen CarePath

This program provides brand name medications at no or low cost

Provided by: Janssen


TEL: 877-227-3728


ALT PHONE: 833-742-0791
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Janssen CarePath Online Enrollment

 

Medications

  • apalutamide tablet (Erleada) Tablet
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Varies
Income Based on FPL
Diagnosis/Medical Criteria Must be used for on-label diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Applicant must call for prescreening
Receiving Patient is contacted if eligible after phone screening
Returning Varies
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor are notified
Decision Timeframe Varies
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Varies
Refill Process Patient or Doctor must contact company
Limit Not specified
Re-application New application, new documentation yearly
   

Additional Information

Call for most recent medications as the list is subject to change.

Updated November 07, 2022


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 4.
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Janssen Support Program

This program provides brand name medications at no or low cost

Provided by: Johnson & Johnson Health Care Systems Inc. (JJHCS)


TEL: 833-742-0791


FAX: 833-512-0497
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Janssen Support Program Patient Assistance Enrollment Form

Janssen Support Program Patient Authorization Form

 

Medications

  • apalutamide tablet (Erleada) Tablet
 

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


Updated November 16, 2022


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 4 of 4.
 

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • apalutamide tablet (Erleada) Tablet
 

Eligibility Requirements   

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

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

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

*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.

Updated November 28, 2022