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Patient Assistance Information

 
 
 
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.
 
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
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader