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Program Details

JOHNSON & JOHNSON PATIENT ASSISTANCE FOUNDATION
Johnson & Johnson Patient Assistance Program

Stelara (ustekinumab)
 
CONTACT INFO
Address: Patient Assistance Program
PO Box 221857
Charlotte, NC 28222-1857
Phone: 1-800-652-6227 Provider Phone:
Fax: 1-888-526-5168 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Patients are eligible who lack access to prescription drug coverage and meet specific financial criteria.
  • Patients actively enrolled in Medicare Part D are only eligible to participate in this program through an exception process if they demonstrate a significant financial hardship and/or medical need.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Patient Consent Form
    Physician License #
    Required:
    Both DEA and State
    NPI
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication or Pharmacy card (see application for details)
    Shipped To: Either Provider and Patient
    Consult application for more details.
    Quantity in Shipment: Not Published
    Delivery Time: 0-1 week
    Re-application Policy: New application every 12 months
    Refill Policy: Refills are automatically sent.
    Other Information:

    Last Updated: 06/12/2013

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)


    Document HIV Common Application



     

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