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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:

  • You must not be covered by any private, public, or Medicare Part D health insurance and prescription coverage programs.
  • You must be a citizen of the United States or it's Territories.
  • You must be an outpatient currently under the care of a physician.
  • 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
    300%
    250%
    200%
    150%
    133%
    100%
    1
    $32,490
    $27,075
    $21,660
    $16,245
    $14,404
    $10,830
    2
    $43,710
    $36,425
    $29,140
    $21,855
    $19,378
    $14,570
    3
    $54,930
    $45,775
    $36,620
    $27,465
    $24,352
    $18,310
    4
    $66,150
    $55,125
    $44,100
    $33,075
    $29,327
    $22,050
    5
    $77,370
    $64,475
    $51,580
    $38,685
    $34,301
    $25,790
    6
    $88,590
    $73,825
    $59,060
    $44,295
    $39,275
    $29,530
    7
    $99,810
    $83,175
    $66,540
    $49,905
    $44,249
    $33,270
    8
    $111,030
    $92,525
    $74,020
    $55,515
    $49,223
    $37,010
    Each Additional Family Member
    $11,220
    $9,350
    $7,480
    $5,610
    $4,974
    $3,740

    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 AAI Pharma Inc. program. Without their help millions of people will be without medication.

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