| Pharmaceutical Company | Ortho-McNeil Pharmaceuticals |
| Program Address | Patient Assistant Program 1800 Robert Fulton Dr., 3rd Floor Reston, VA 20191 |
| Toll Free Phone Number | 800-797-7737 |
| Alternate Phone Number | None |
| Fax Number | None |
| Guidelines and Notes | The program is for patient's who are medically indigent. The doctor determines patient eligibility when he/she signs the application attesting that he/she believes the patient is medically indigent. If there are questions, call the company between 9:00 a.m. to 5:00 p.m. Eastern Time. The applications differ depending on the medication. The applications are patient specific. |
| Initiating Enrollment | Anyone can register by phone. The form is sent directly the doctor. Information needed when requesting a form include the patient's name, Social Security Number, and date of birth; the doctor's name, DEA number, address and phone; and the drug's name and dose. The applications are drug specific. |
| Health Provider's Role | The doctor completes and signs the form, attaches a prescription, and mails. The doctor must attest that he/she believes the patient is indigent and has no insurance for medications. |
| Patient's Role | Minimal information is required. |
| How Dispensed | Sent to the doctor's office. |
| Amount Dispensed | Varies - depends on the medication. |
| Estimated Response Time | Not specified |
| Refills | The doctor's office call the company to attest the patient is still in need. |
| Limit | Unspecified |