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Patient Assistance Information

 
2 Programs for Concerta XR Tablets
 
 
Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program

PO Box 221857
Charlotte, NC 28222
Phone : (800)652-6227
Fax: (888)526-5168
Eligibility
> 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
> Applications can be obtained by patients and doctors by calling or downloading from the link below.
Required
> 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.
Supply
> Not specified. Refill process varies by medication.
Ship To
> Doctor's office or a card will be sent to the patient to used at the pharmacy.
Note
>
 
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.
 
Concerta XR Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader
 
 
McNeil Consumer and Specialty Pharmaceuticals PAP

McNeil Consumer and Specialty Pharmaceuticals PAP
PO Box 1015
San Bruno, CA 94066
Phone : (866) 727-4626
Fax:
Eligibility
> Eligibility is based on income and lack of third party prescription coverage.
Who Can Apply
> Physician's office must apply on patient's behalf.
Required
> A completed application with the physician's original signature and patient's income documentation are required.
Supply
> Flexeril is provided in a 90 day supply. For patients on Concerta, a six month supply of coupons is provided, each good for a thirty day prescription.
Ship To
> Physician's office or patient's home.
Note
> Physician must certify medical need. Income and insurance (indicating no prescription coverage) documentation must accompany application.
 
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.
 
Concerta XR Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
Download printable Form Application Form
(Requires Acrobat Reader