Step 1
Check to see if you’re eligible for the program or view eligibility requirements.
Step 2
Eligible? Get the application.
or Call 800-652-6227 to have one mailed or faxed to you.
If you’re taking HIV medications that aren’t covered by this program, please go to the HarborPath website to access the HarborPath Patient 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 and sign page 3 of the application.
Step 5
Submit completed application page 2 and 3 only with documentation to:
Fax: 888-526-5168 (toll free) or 740-966-1797 (direct dial)
Mail:
Johnson & Johnson Patient Assistance Foundation, Inc.
Patient Assistance Program
P.O. Box 0367
Chesterfield, MO 63006