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Aciphex Patient Assistance Program

Summary

Johnson & Johnson Health Care Systems, Inc. is the parent company of Ortho-McNeil, Inc., creators of AcipHex. The goal of Orth-McNeil is to improve on the current state of patient care through the development of safe and effective treatments. PriCara, Unit of Ortho-McNeil, Inc., aims to provide new and improved solutions to health care professionals as no United State health care organization has done before.

AcipHex was launched by Johnson & Johnson Health Care Systems, Inc in 1999. It is used as a treatment for Gastroesophageal Reflux Disease, heartburn, ulcers, and Zollinger-Ellison syndrome. AcipHex is available in tablet form.

Eligibility

Johnson & Johnson Health Care Systems Inc., a division of the Johnson & Johnson company, manages the patient assistance program for PriCara, Unit of Ortho-McNeil, Inc..Their patient assistance program, Access 2 Wellness, offers up to a 1 year supply of Aciphex at no cost to those who are eligible for the program. Eligibility is based off of the following requirements:

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You must not be covered by any private, public, or Medicare Part D health insurance and prescription coverage programs.

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You must be a citizen of the United States or it's Territories.

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You must be an outpatient currently under the care of a physician.

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Your income must be less than or equal to 200% of the Federal Poverty Guideline for the size of your household (see chart below).

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 Johnson & Johnson Health Care Systems, Inc 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 Johnson & Johnson Health Care Systems, Inc 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 Johnson & Johnson Health Care Systems, Inc program. Without their help millions of people will be without medication.

PAP Links:

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List of Medications

Aciphex Tablets 20mg (rabeprazole)

Forms and other information are Copyright © Aciphex Patient Assistance Program

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