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Patient Assistance Information

 
 
 
Hospital Access Patient Assistance Program

PO Box 220455
Charlotte, NC 28222-0455
Phone : 800-652-6227
Fax: 800-521-2437
Eligibility
> 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
> Applications must be obtained by a representative from the hospital by calling or downloading.
Required
> Applications can be faxed or mailed. The hospital must complete a product request form for each replacement.
Supply
> Not specified.
Ship To
> Hospital
Note
> 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).
 
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.
 
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
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader