Erleada Patient Assistance Programs

Erleada: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Erleada. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Johnson & Johnson Patient Assistance Foundation, Inc. Patient Assistance Program

(Program 1 of 2 — Scroll down to see them all)

Provided by: Johnson & Johnson Patient Assistance Foundation, Inc.
PO Box 42796 Cincinnati, OH 45242
TEL: 800-652-6227
FAX: 888-526-5168
Languages Spoken:
English
Program Website
Medications
  • Erleada (apalutamide)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? *See Additional Information Section Below
  • Income Varies. **See below for details
  • Diagnosis/Medical Criteria Medication must be for outpatient use only
  • U.S. Residency Required? The patient must also be permanently residing in the US or US territories.
Application
  • Obtaining Call or download
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Not specified
  • Sent To Doctor's office or patient is sent card to be used at pharmacy
  • Delivery Time Varies
  • Refill Proces Varies per medication
  • Limit Varies
  • Re-application New application, new documentation yearly
Additional Information
*Some Medicare Part D patients who cannot afford their medicines, and who meet certain financial criteria, may also be eligible for assistance. Please Contact the program for more information (1-800-652-6227). **Please call 1-800-652-6227 or visit Program website for specific FPL income requirements.
Updated July 18, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Erleada prices here.

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Patient Access Network Foundation (PAN)

(Program 2 of 2 — Scroll down to see them all)

Provided by: Patient Access Network Foundation
None
TEL: 866-316-7263
FAX: 866-316-7261
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Erleada (apalutamide)
Eligibility Requirements
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must reside and receive treatment in US
Application
  • Obtaining Call or complete online
  • Receiving Complete online or by phone
  • Returning Complete online or by phone
  • Doctor's Action Will be discussed with patient and Doctor after request is received
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within 48 hours
Medication
  • Amount/Supply Not applicable
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Once approved; shipped same day
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit None
  • Re-application New application every 12 months
Additional Information
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Updated July 10, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Erleada prices here.

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