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Janssen Ortho Patient Assistance Foundation Patient Assistance Program
SOURCE: 2008 Poverty Chart
| Family Size | 100% | 133% | 150% | 200% | 250% | 300% |
| 1 | $10,830 | $14,404 | $16,245 | $21,660 | $27,075 | $32,490 |
| 2 | $14,570 | $19,378 | $21,855 | $29,140 | $36,425 | $43,710 |
| 3 | $18,310 | $24,352 | $27,465 | $36,620 | $45,775 | $54,930 |
| 4 | $22,050 | $29,327 | $33,075 | $44,100 | $55,125 | $66,150 |
| 5 | $25,790 | $34,301 | $38,685 | $51,580 | $64,475 | $77,370 |
| 6 | $29,530 | $39,275 | $44,295 | $59,060 | $73,825 | $88,590 |
| 7 | $33,270 | $44,249 | $49,905 | $66,540 | $83,175 | $99,810 |
| 8 | $37,010 | $49,223 | $55,515 | $74,020 | $92,525 | $111,030 |
| For each additional family member | $3,740 | $4,974 | $5,610 | $7,480 | $9,350 | $11,220 |
What´s Next?
Fill out the program enrollment form located to your right. If you don’t see an enrollment form available please call Janssen Ortho Patient Assistance Foundation program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.
Other Tips
- If you have any questions please call the Janssen Ortho Patient Assistance Foundation program directly
- Fill out as much of the information on the enrollment form as possible. The more information you have pre-filled the easier the progrm is to enroll in
- Write down the refill dates for your program and set a reminder here on PatientAssistance.com so that you don’t run out of medication.
- Do not write messy on your forms as this will delay any response
- Call and write thank you notes to Janssen Ortho Patient Assistance Foundation program. Without their help millions of people will be without medication.
- PAP Links:
- Website:
- Address:
- Phone:
- Fax:
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List of Medications
Aciphex Tablets (rabeprazole Sodium), Alamast Ophthalmic Solution 0.1% (pemirolast Potassium), Axert Tablets 6.25mg, 12.5mg (almotriptan), Betimol Ophthalmic Solution 0.25%, 0.5% (timolol), Biafine Topical Emulsion 45gram Tube, 90gram Tube (biafine), Concerta Tablets 18mg, 27mg, 36mg, 54mg (methylphenidate), Doxil Injection (doxorubicin Hcl Liposome), Duragesic CII Patch (fentanyl Patch), Elmiron Capsules (pentosan Polysulfate Sodium), Ertaczo Cream 2% (sertaconazole Topical), Flexeril Tablets 5mg, 10mg (cyclobenzaprine), Grifulvin V Suspension (griseofulvin), Grifulvin V Tablets (griseofulvin), Haldol Injection (haloperidol), Haldol Injection (haloperidol Injection), Intelence Tablets (etravirine), Invega Extended-Release Tablets 3mg, 6mg, 9mg (paliperidone), Iquix Ophthalmic Solution (levofloxacin), Leustatin Injection (cladribine), Levaquin Oral Solution (levofloxacin), Levaquin Tablets 250mg, 500mg, 750mg (levofloxacin), Natrecor Injection 1.5mg (nesiritide), Orthovisc (high Molecular Weight Hyaluronan), Pancrease MT 10 Tablets 10000units/30000units/30units (lipase/amylase/protease), Pancrease MT 20 Capsules 20000units/56000units/44000units (lipase/amylase/protease), Pancrease MT 4 Capsules 4000units/12000units/12000units (lipase/amylase/protease), Pancrease MT16 Capsules 16000units/48000units/48000units (lipase/amylase/protease), Parafon Forte DSC (chlorzoxazone), Prezista Tablets (darunavir), Procrit Injection (epoetin Alfa), Quixin Ophthalmic Solution 0.5% (levofloxacin), Razadyne Oral Solution 4mg/ml (galantamine), Razadyne Tablets 4mg, 8mg, 12mg (galantamine), Razadyne ER Capsules 8mg, 16mg, 24mg (galantamine), Regranex Gel 0.01% (becaplermin), Remicade IV Injection (infliximab), Retin-A Cream (tretinoin Topical), Retin-A Gel (tretinoin Topical), Retin-A Liquid (tretinoin Topical), Retin-A Micro (tretinoin Topical), Risperdal Oral Solution 1mg/1ml (risperidone), Risperdal Tablets 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg (risperidone), Risperdal Consta Long Acting Injection 25mg, 37.5mg, 50mg (risperidone), Risperdal M Tablets 5mg (risperidone), Sporanox Capsules (itraconazole), Sporanox Oral Solution (itraconazole), Terazol 3 Suppository (terconazole Vaginal), Terazol 3 Vaginal Cream (terconazole Vaginal), Terazol 3 Vaginal Suppository (terconazole Vaginal), Terazol 7 Vaginal Cream (terconazole Vaginal), Topamax Sprinkle Capsules 15mg (topiramate), Topamax Tablets 25mg, 50mg, 100mg, 200mg (topiramate), Topamax Tablets (topiramate), Ultracet Tablets 37.5mg (acetaminophen/tramadol), Ultram Tablets 50mg (tramadol), Ultram ER Tablets (tramadol Hcl)
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