Johnson and johnson patient assistance program application pdf

Frequently Asked Questions

Eligibility requirements

Am I eligible if I have Medicare or Medicaid insurance or prescription drug coverage?

Am I eligible if I live in a state that now offers Medicaid?

Do I need to live in the United States to be eligible for this program?

Applying for the program

How can I apply for the program?

Is there a fee to apply for the program?

Do I need to provide any documents that show my income level?

Since I last filed taxes, I’ve lost my job or have had financial troubles. Should I mention that on my application?

Why does my doctor need to complete part of the application?

How will I know if I’m approved for the program? How long will it take to find out?

How can I check the status of my application?

Do I need to reapply if I need another medicine?

Receiving medicines

How will I receive the medicine if I’m approved?

Do I have to pay a copay for my medicine?

How long will I receive free medicines if I’m approved?

Insurance coverage and the Affordable Care Act

My insurance partially covers the cost of my prescriptions. Will this program cover the rest?

What should I know about the Affordable Care Act?

Supporting patients in an outpatient hospital setting

I work for a hospital and am interested in ordering free medications to give to qualified patients in the outpatient setting directly. Is there a program for this?

About the Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF)

What does the JJPAF do?

Does the JJPAF provide individuals with grants or funding?

Do you provide the Johnson & Johnson Family of Companies’ baby products and over-the-counter medicines?

Step 2

Eligible? Get the application.

Step 3

Complete the application.

  • Read the application instructions carefully.
  • Complete and sign page 2.
  • Include a copy of the front and back of your insurance cards(s).
  • Provide proof of income (Choose one): Check the box in section 4 on page 2 OR include a copy of your most recent 1040 or 1040-SR Federal tax return.

Step 4

Have your doctor complete their sections of the application, and sign and date in the "HCP Authorization" section(s) for the product(s) they have prescribed.

Step 5

Submit completed page 2 and the pages your HCP has completed for your prescribed product(s) with documentation to:

Next Steps

We will review your application

Once we receive your application, it will take about three days to review. If the application is missing information, it will take longer. Upon completion of review, we’ll send you a letter to let you know whether you’re eligible. When you apply, please be sure to include all your supporting documents.

If you’re approved

The specialty pharmacy will ship this prescription product directly to the address your healthcare provider has requested on the application. We’ll send you a letter that tells you exactly how you’ll receive your medicine.

You can reapply each year

Once approved, you’ll receive the medicines you need for up to one year. Before your enrollment ends, we’ll send you a reminder to renew your application for next year.

What is The Patient Assistance Program?

The Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF) is an independent, nonprofit organization. JJPAF gives eligible patients free prescription medicines donated by Johnson & Johnson companies.

Since 2005, we’ve helped more than 500,000 people get free access to the medicines they
otherwise wouldn’t receive.

Program Update

Patients may now choose the option of electronic income verification. Instead of submitting a copy of their Federal tax return, they can simply check a box on the updated application form.

Am I Eligible?

It’s easy to find out—just answer a few simple questions.

How does the Johnson and Johnson Patient Assistance Program work?

The Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF) is an independent, nonprofit organization. JJPAF gives eligible patients free prescription medicines donated by Johnson & Johnson companies. otherwise wouldn't receive.

What is PPA assistance?

The Partnership for Prescription Assistance (PPA) is free and confidential service that helps connect uninsured and underinsured patients who struggle with affordable access to medicines to prescription assistance programs that offer medicines for free or nearly free.

How do you qualify for free eliquis?

You may be eligible for the Free 30-Day Trial Offer for ELIQUIS® (apixaban) if:.
You have not previously filled a prescription for ELIQUIS;.
You have a valid 30-day prescription for ELIQUIS;.
You are being treated with ELIQUIS for an FDA-approved indication that an HCP has planned for more than 35 days of treatment;.

Is there a patient assistance program for vascepa?

Vascepa Savings Card Program: Eligible patients pay as little as $9 with a savings of $150 per 30-day fill; maximum savings of $2250 annually; for additional information contact the program at 855-497-8462.

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