Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program (Eisai)

Eisai Inc.

Contact Information
Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program
P.O. Box 220458
Charlotte, NC 28222-0458
1-(800) 523-5870 (phone)
1-(800) 226-5059 (fax)
Physician requests should be directed to:
Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program
P.O. Box 220458
Charlotte, NC 28222-0458
1-(800) 523-5870 (phone)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Eligibility:
Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF) Patient Assistance Program provides the products donated by Eisai Inc. free of charge to those U.S. residents who lack access to prescription drug coverage and meet specific financial criteria. Medicare LIS (Low Income Subsidy) eligible patients are not eligible to receive assistance through the Janssen Ortho Patient Assistance Foundation Patient Assistance Program. Patients receiving benefits under a Medicare Part D prescription drug plan are not eligible to receive assistance through the Patient Assistance Program, however program eligibility exceptions for Medicare Part D enrollees based on significant financial or medical need will be considered.
Other Information:
If necessary, patients may reapply after initial supply.
Product(s) covered by program:
  • Aciphex®