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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Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program - Pulmonary Arterial Hypertension (PAH) Products

This program provides medication at no cost.

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

610 Crescent Executive Court
Suite 200
Lake Mary, FL 32746

TEL: 833-919-3510


ALT PHONE: 308-920-4358
FAX: 833-919-3509 		Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program (PAH) Application
 

Medications
  • macitentan tablet (Opsumit) 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 proof of income
Decision Communicated Patient and Doctor notified in writing
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 (1-833-929-3510).

**Please call 1-833-929-3510 or visit Program website for specific FPL income requirements.
Updated April 14, 2022


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

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
  • macitentan tablet (Opsumit) 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 Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication
Amount/Supply Not applicable
Sent To Patient sent 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 April 25, 2022