Patient assistance
May provide SIMPONI at no cost for up to one year to eligible patients with inadequate coverage who meet current income and program criteria.
What it does
Evaluates coverage, income, residence, prescription, and provider information. The current SIMPONI form includes the patient-assistance request and provider prescription workflow.
Open official program pagePotentially available to eligible US patients with no or inadequate coverage who meet household-income and medicine-specific requirements.
Complete the patient and assistance sections of the current SIMPONI form.
Provide income, insurance, and denial evidence requested by the program.
Call for screening or use the current REMICADE and SIMPONI gastroenterology patient enrollment form. Patient and prescriber submit their sections with income, coverage, authorization, and prescription information.
Best for: Services requiring clinical information, a prescription, or prescriber attestation
Patient completes demographics and the authorization/consent section of the official form.
Owner: Patient
Have ready: Contact information, Signature and date
Patient, Prescriber And Clinic Staff, Johnson & Johnson Patient Assistance Program
SIMPONI withMe Case Manager
Benefits, affordability, pharmacy shipment, and treatment logistics.
Monday-Friday, 8 AM-8 PM ET
SIMPONI Nurse Support
Injection and treatment education within program scope.
Monday-Friday, 9 AM-8 PM ET; after-hours callback is typically advertised within 15 minutes
Complete the prescriber section and valid prescription.
Prescriber completes the prescription, clinical, insurance, and service-selection sections and attaches supporting records.
Owner: Prescriber or clinic staff
Have ready: Patient authorization, Income evidence, Insurance or denial evidence, Provider section, Prescription
Best for: Patients who may lack adequate SIMPONI coverage
Provide the requested prescription, insurance, contact, and consent information.
Owner: Patient or caregiver
Have ready: Prescription details, Insurance card, Prescriber contact information
After enrollment: The program communicates eligibility and dispensing instructions if approved.
If there is a problem: Call to identify missing patient, provider, income, coverage, prescription, or signature information.
Current official enrollment and prescription form.
Current J&J immunology materials describe core patient-assistance criteria.
Official affordability pathway chart.
