
Step 1
Check to see if you’re eligible for the program or view eligibility requirements.


Step 3
Complete the application.
- Read the application instructions carefully.
- Complete and sign pages 2 and 3.
- Include a copy of the front and back of your insurance cards(s).
- Provide proof of income (Choose one): Check the box in section 5 on page 3 OR include a copy of your most recent 1040 or 1040-SR Federal tax return.

Step 4
Have your doctor complete and sign page 4 of the application.

Step 5
Submit completed application pages 2 thru 4 only with documentation to:
Fax: 1-888-526-5168 (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