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 1-800-652-6227
to have one mailed or faxed to you.

If you’re taking HIV medications that aren’t covered by this program, you can instead fill out the HarborPath Patient Application on the HarborPath Portal.

Step 3

Complete the application.

  • Read the application instructions carefully.
  • Complete pages 1 and 2, and sign page 2.
  • Include a copy of your most recent 1040 or 1040EZ federal tax return. If you don’t file taxes, note that on the application.

Step 4

Have your doctor complete and sign pages 3 and 4 of the application.

Step 5

Fax or mail us your completed application, along with your most recent 1040 or 1040EZ federal tax return.

Fax: 1-888-526-5168

Mail: Johnson & Johnson Patient Assistance Foundation, Inc.
Patient Assistance Program
P.O. Box 221857
Charlotte, NC 28222-1857

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, like your recent tax return.

If you’re approved

Depending on which medicine you need, you’ll be able to pick it up at your doctor’s office, a local or mail order pharmacy with your Pharmacy Card, or sent to your home. 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.

Are you taking other HIV medications that are not covered in this program?

If so, instead you can access the HarborPath Patient Application on the HarborPath Portal