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Hospital Access Patient Assistance Program
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PO Box 220455
Charlotte, NC 28222-0455
Phone
:
800-652-6227
Fax:
800-521-2437
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Eligibility
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The Johnson & Johnson Patient Assistance Foundation, Inc. Hospital Access Patient Assistance Program provides medication at no cost for patients that are uninsured. Income requirements are based on the Federal poverty level. Patients must reside in the US or a US territory. |
| Who Can Apply
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Applications must be obtained by a representative from the hospital by calling or downloading. |
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Required
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Applications can be faxed or mailed. The hospital must complete a product request form for each replacement. |
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Supply
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Not specified. |
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Ship To
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Hospital |
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Note
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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). |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Edurant tablet |
| Intelence Tablet |
| Invega Extended Release Tablets |
| Invokamet tablet |
| Invokana tablet |
| Levaquin Tablets |
| Prezcobix tablet |
| Prezista Tablets |
| Procrit Solution |
| Risperdal M-TAB Tablets |
| Risperdal Tablets |
| Topamax Sprinkle Capsules (topiramate) |
| Topamax Tablets (topiramate) |
| Xarelto tablet |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program
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PO Box 221857
Charlotte, NC 28222
Phone
:
(800)652-6227
Fax:
(888)526-5168
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Eligibility
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The Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program provides brand name medications at no or low cost. Patients must have prescription coverage the needed medication. Some Medicare Part D patients who cannot afford their medicines, and who meet certain financial criteria, may also be eligible for assistance. Patient must permanently reside in the US or a US territory. |
| Who Can Apply
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Applications can be obtained by patients and doctors by calling or downloading from the link below. |
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Required
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Applications must be completed and signed by both the patient and doctor. Proof on income must also be attached. New application and documentation is needed every year. |
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Supply
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Not specified. Refill process varies by medication. |
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Ship To
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Doctor's office or a card will be sent to the patient to used at the pharmacy. |
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Note
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Axert Tablets |
| Concerta XR Tablets |
| Darzalex |
| Doxil Injection |
| Duragesic CII Patch |
| Edurant tablet |
| Elmiron Capsules |
| Haldol Decanoate Injection |
| Haldol Injection |
| Imbruvica capsule |
| Intelence Tablet |
| Invega Extended Release Tablets |
| Invega Sustenna injection; extended release |
| Invega Trinza injection for suspension; extended release |
| Invokamet tablet |
| Invokana tablet |
| Levaquin Oral Solution |
| Levaquin Tablets |
| Monovisc injection |
| Olysio capsule |
| OrthoVisc Solution |
| Pancrease Capsules |
| Prezcobix tablet |
| Prezista Tablets |
| Procrit Solution |
| Razadyne ER Capsules |
| Razadyne Tablets |
| Razadyne Oral Solution |
| Remicade (infliximab) |
| Risperdal Consta Long Acting Injection |
| Risperdal M-TAB Tablets |
| Risperdal Oral Solution |
| Risperdal Tablets |
| Simponi |
| Simponi Aria |
| Sporanox Capsules |
| Stelara injection |
| Sylvant |
| Topamax Sprinkle Capsules (topiramate) |
| Topamax Tablets |
| Xarelto tablet |
| Yondelis |
| Zytiga tablet |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
| (Requires Acrobat Reader)
|
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