Am I eligible for the program?

Our free prescription program is available to anyone who meets the requirements listed below.

  • You don’t have any insurance or your medicine is not covered. Some Medicare Part D patients who cannot afford their medicines, and who meet certain financial criteria, may also be eligible for assistance.
  • You live in the United States or United States Territory, and you are being treated by a licensed U.S. doctor as an outpatient.
  • You meet the income eligibility for the products below:
Medication
Select Family Size

CONCERTA® †
(methylphenidate HCI) Extended-Release Tablets CII

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

DARZALEX®
(daratumumab) Injection for intravenous infusion

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

DOXIL® †
(doxorubicin HCL liposome) IV Infusion

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

DURAGESIC® †
(fentanyl) Transdermal System CII

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

EDURANT® 1
(rilpivirine) Tablets

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

ELMIRON®
(pentosan polysulfate sodium) Capsules

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

HALDOL® †
(haloperidol) Immediate-Release Injection

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

HALDOL® Decanoate
(haloperidol) IM Injection Only

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

IMBRUVICA®
(ibrutinib) Capsules

$72,360 $97,440 $122,520 $147,600 $172,680 Variable – please call us for more information

INTELENCE® 1
(etravirine) Tablets

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

INVEGA SUSTENNA® †
(paliperidone palmitate) Extended-Release Injectable Suspension

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

INVEGA TRINZA®
(paliperidone palmitate) Extended-Release Injectable Suspension

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

INVOKAMET®† 1
(canagliflozin/metformin HCI) Tablets

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

INVOKAMET® XR† 1
(canagliflozin/metformin HCI) Tablets

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

INVOKANA®† 1
(canagliflozin) Tablets

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

MONOVISC®
(high molecular weight hyaluronan) Injection

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

OLYSIO®
(simeprevir) Capsules

$60,300 $81,200 $102,100 $123,000 $143,900 Variable – please call us for more information

ORTHOVISC®
(high molecular weight hyaluronan) Injection

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

PANCREAZE®
(pancrelipase) Delayed-Release Capsules

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

PREZCOBIX®1
(darunavir 800mg/cobicistat 150mg) Tablets

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

PREZISTA® 1
(darunavir) Tablets/Oral Suspension

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

PROCRIT® † 1
(epoetin alfa) Injection

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

REMICADE® †
(infliximab) IV Infusion

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

RISPERDAL CONSTA® †
(risperidone) Long-Acting Injection

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

SIMPONI® †
(golimumab) Injection

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

SIMPONI ARIA®
(golimumab) IV Infusion

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

SPORANOX® †
(itraconazole) Capsules

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

SPORANOX® †
(itraconazole) Oral Solution

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

STELARA®
(ustekinumab) Injection, for subcutaneous or intravenous use

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

SYLVANT®
(siltuximab) IV Infusion

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

TREMFYA™
(guselkumab) Injection, for subcutaneous use

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

XARELTO® † 1
(rivaroxaban) Tablets

$36,180 $48,720 $61,260 $73,800 $86,340 Variable – please call us for more information

YONDELIS®
(trabectedin) Injection for intravenous infusion

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

ZYTIGA®
(abiraterone acetate) Tablets

$48,240 $64,960 $81,680 $98,400 $115120 Variable – please call us for more information

† Please see full U.S. prescribing information, including Black Box warning for: CONCERTA®, DOXIL®, DURAGESIC®, HALDOL®, HALDOL® DECANOATE, INVEGA SUSTENNA®, INVEGA TRINZA®, INVOKAMET®, INVOKAMET® XR, INVOKANA®, PROCRIT®, REMICADE®, RISPERDAL CONSTA®, SIMPONI®, SIMPONI ARIA®, SPORANOX®, SPORANOX® ORAL SOLUTION, XARELTO®

1 These products are also available for hospital outpatients in our Hospital Access Patient Assistance Program