How to Apply

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) /
308-920-4358 (direct dial)
to have one mailed or faxed to you.

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:

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

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.