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Hospital Access Patient Assistance Program
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PO Box 220455
Charlotte, NC 28222-0455
Phone
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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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| Prezista Tablets |
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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.
|
| Prezista Tablets |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
| (Requires Acrobat Reader)
|
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Patient Access Network Foundation (PAN)
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PO Box 221858
Charlotte, NC 28222
Phone
:
(866)316-7263
Fax:
(866)316-7263
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Eligibility
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This is a copay assistance program for patients that have health insurance. The patient's insurance must cover the qualifying medication that they are seeking assistance for. Patient with Medicare Part D will be considered on a case by case basis. Patients must be at or below 400-500% of the federal poverty level, must have a medically appropriate diagnosis/condition and must reside and receive treatment in the US. |
| Who Can Apply
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Patients or healthcare providers can complete the application online or by phone. |
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Required
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Patients must call for information or inform their doctor that they are in need. Doctors action will be discussed with the patient and doctor after the request is received. |
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Supply
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Not applicable |
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Ship To
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Patient sent card to be used at pharmacy |
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Note
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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. |
| |
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.
|
| Prezista Tablets |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
| (Requires Acrobat Reader)
|
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Prezista Patient Assistance Program
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PO Box 1016
San Bruno, CA 94066
Phone
:
866-836-0114
Fax:
866-836-0567
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Eligibility
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The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. The patient must also be residing the US. |
| Who Can Apply
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Up to a 90-day supply |
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Ship To
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Note
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
| |
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.
|
| Prezista Tablets |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form Application Form |
| (Requires Acrobat Reader)
|
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