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Topiramate Patient Assistance Programs

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Or go to the main Patient Assistance Programs page>>

Topamax: Apply for prescription assistance below


If you are eligible, the programs below can help you afford Topamax. 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.



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


(Program 1 of 6. Scroll down to see them all.)

Provided by: Johnson & Johnson Patient Assistance Foundation, Inc.
PO Box 220455 Charlotte, NC 28222-0455

TEL: 800-652-6227
FAX: 800-521-2437
Languages Spoken:
English
Program Website
 

Program Applications and Forms

  • Johnson & Johnson Hospital Access Patient Assistance Program Application (PDF)

Medications
  • Topamax tablet (topiramate)

Eligibility Requirements   
Insurance Status Must be uninsured
Those with Part D Eligible? Not specified
Income Based on FPL
Diagnosis/Medical Criteria Not applicable
US Residency Required? Must be residing in the US or US territory

Application
Obtaining Representative from the hospital must call for an application or download it from the website
Receiving Faxed, mailed or downloaded from website
Returning The completed application can be faxed or mailed back.
Doctor's Action Hospital must complete product request form for each replacement
Applicant's Action Not specified
Decision Communicated Not specified
Decision Timeframe Not specified

Medication
Amount/Supply Not specified
Sent To Hospital
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application New application, new documentation yearly

Additional Information
This program allows eligible hospitals to receive free medications to give to qualified outpatients directly. Contact the program for more details (1-800-652-6227).

Updated 1/12/2017

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


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


(Program 2 of 6. Scroll down to see them all.)

Provided by: Johnson & Johnson Patient Assistance Foundation, Inc.
PO Box 221857 Charlotte, NC 28222-1857

TEL: 800-652-6227
FAX: 888-526-5168
Languages Spoken:
English
Program Website
 

Program Applications and Forms

  • HIV Common Application: Johnson & Johnson Patient Assistance Foundation, Inc. (PDF)
  • Johnson & Johnson Patient Assistance Foundation, Inc. Patient Application (PDF)

Medications
  • Topamax capsule; sprinkle (topiramate)
  • Topamax tablet (topiramate)

Eligibility Requirements   
Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? *See Additional Information Section Below
Income Varies. **See below for details
Diagnosis/Medical Criteria Medication must be for outpatient use only
US 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 Process 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 1/12/2017

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


Supernus Patient Assistance Program


(Program 3 of 6. Scroll down to see them all.)

Provided by: Supernus Pharmaceuticals, Inc.
c/o The Lash Group, Inc. 9717 Key West Avenue Rockville, MD 20850

TEL: 866-398-0833
FAX: 855-998-1515
Languages Spoken:
English
Program Website
 

Program Applications and Forms

  • Supernus Patient Assistance Program Service Request Form for Oxtellar XR (PDF)
  • Supernus Patient Assistance Program Service Request Form for Trokendi XR (PDF)

Medications

Eligibility Requirements   
Insurance Status Must be uninsured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? The patient must also be a US resident.

Application
Obtaining Download from website
Receiving Downloaded from website
Returning The completed application must be faxed back.
Doctor's Action Complete section and sign
Applicant's Action Complete section and sign
Decision Communicated Not specified
Decision Timeframe Not specified

Medication
Amount/Supply Up to 1 month supply
Sent To Patient's home
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit Not specified
Re-application New application yearly

Additional Information
This program also provides copay assistance. www.oxtellarxr.com www.trokendixrhcp.com

Updated 11/21/2016

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


Rx Outreach Medications


(Program 4 of 6. Scroll down to see them all.)

Provided by: Rx Outreach
PO Box 66536 St Louis, MO 63166-6536

TEL: 888-796-1234
FAX: 800-875-6591
Languages Spoken:
English, Spanish
Program Website
 

Program Applications and Forms

  • Rx Outreach Application (PDF)
  • Rx Outreach Diabetic Supplies Order Form (Prodigy) (PDF)
  • Rx Outreach Medication List (PDF)
  • Rx Outreach Medication List (Spanish) (PDF)
  • Rx Outreach Refills and New Prescription Form (PDF)

Medications
  • Topamax (topiramate)

Eligibility Requirements   
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? The patient must also be residing in the US.

Application
Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax or E-Prescribe online
Doctor's Action Give prescription to patient
Applicant's Action Complete section and sign
Decision Communicated Medications sent if accepted. If denied patient and doctor notified
Decision Timeframe Usually same day

Medication
Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit Only limited by manufacturer's guidelines
Re-application New application yearly

Additional Information
Some medications are available for a fee of $20 for up to a 180 day supply. Check the Rx Outreach website for the exact price and most current medication list. Contact Program for Spanish Application(s)/Form(s).

Updated 11/15/2016

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


Rx Outreach Medications


(Program 5 of 6. Scroll down to see them all.)

Provided by: Rx Outreach
PO Box 66536 St Louis, MO 63166-6536

TEL: 888-796-1234
FAX: 800-875-6591
Languages Spoken:
English, Spanish
Program Website
 

Program Applications and Forms

  • Rx Outreach Application (PDF)
  • Rx Outreach Diabetic Supplies Order Form (Prodigy) (PDF)
  • Rx Outreach Medication List (PDF)
  • Rx Outreach Medication List (Spanish) (PDF)
  • Rx Outreach Refills and New Prescription Form (PDF)

Medications
  • Topamax (topiramate)

Eligibility Requirements   
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? The patient must also be residing in the US.

Application
Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax or E-Prescribe online
Doctor's Action Give prescription to patient
Applicant's Action Complete section and sign
Decision Communicated Medications sent if accepted. If denied patient and doctor notified
Decision Timeframe Usually same day

Medication
Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit Only limited by manufacturer's guidelines
Re-application New application yearly

Additional Information
Some medications are available for a fee of $20 for up to a 180 day supply. Check the Rx Outreach website for the exact price and most current medication list. Contact Program for Spanish Application(s)/Form(s).

Updated 11/15/2016

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


Xubex Patient Assistance Program


(Program 6 of 6. Scroll down to see them all.)

Provided by: Xubex
PO Box 1244 Winter Park, Fl 32790-1244

TEL: 866-699-8239
ALT PHONE: 407-478-2663
FAX: 407-671-7960
Languages Spoken:
English
Program Website
 

Program Applications and Forms

  • Xubex Patient Assistance Program Physician Order Sheet (page 3) (PDF)
  • Xubex Patient Assistance Program Registration Form (pages 1 & 2) (PDF)

Medications

Eligibility Requirements   
Insurance Status May have insurance
Those with Part D Eligible? Yes, but contact program for details
Income No limits
Diagnosis/Medical Criteria Not specified
US Residency Required? The patient must also be a US resident.

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 Give prescription to patient
Applicant's Action Complete section and sign
Decision Communicated Not specified
Decision Timeframe Not specified

Medication
Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Within 10 days
Refill Process Automatically sent out
Limit Varies per medication
Re-application New application, new documentation yearly

Additional Information
No proof of income is required. Check the website for the exact price. This service is not currently available in Montana.

Updated 10/31/2016

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


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