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Program Details

JOHNSON & JOHNSON PATIENT ASSISTANCE FOUNDATION
J&J Hospital Access Patient Assistance Program

Xarelto (rivaroxaban tablets)
 
CONTACT INFO
Address:
,
Phone: 1-800-652-6227 Provider Phone:
Fax: Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Hospitals can apply for this program if they're currently enrolled in the 340B Drug Pricing Program, which requires drug manufacturers to provide outpatient medications at reduced prices. To apply, hospitals must also be classified as a Disproportionate Share Hospital (a hospital that treats patients who don't have insurance or aren't eligible for other health care coverage).
  • Hospitals can apply online via the HAPAP Portal: http://www.jjpaf.org
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Not Published
    US citizenship/residency specified: Not Published
    APPLICATION
    Attachments Required: Not Published
    Physician License #
    Required:
    Not Published
    Prescriber Signature
    Allowed:
    Not Published
    Application may be
    faxed:
    Not Published
    Eligibility determination
    letter sent:
    MEDICATION
    Receives: Medication
    Shipped To: Hospital
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: New application every 12 months
    Refill Policy: Not Published
    Other Information:

    Last Updated: 12/07/2021

     

     

     


    Application Forms
    & Instructions

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



     

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