Step 1
Check to see if you’re eligible for the program or view eligibility requirements.
Step 2
Eligible? Get the application.
or Call 833-919-3510 (toll free) /
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 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 application pages 2 thru 8 only with documentation to:
Fax: 833-919-3509 (toll free) / 240-575-3932 (direct dial)
Mail:
Johnson & Johnson Patient Assistance Foundation, Inc.
610 Crescent Executive Court, Suite 200
Lake Mary, FL 32746