IMAAVY

Indicated For

generalized myasthenia gravis, gMG

About This Medication

# Johnson & Johnson Patient Assistance Program Guide: How to Get IMAAVY at Low or No Cost ## About IMAAVY (Nipocalimab) IMAVY is a prescription medication prescribed by healthcare providers to treat eligible patients. If you've been prescribed IMAAVY but are concerned about the cost, the Johnson & Johnson Patient Assistance Program may help you receive your medication at no cost for up to one year. ## Who Qualifies for This Program? You may be eligible for the Johnson & Johnson Patient Assistance Program if you meet ALL of the following requirements: - You live in the United States or a U.S. territory (including Puerto Rico) - Your household income is below a certain level (varies by family size) - You are uninsured OR have inadequate prescription drug coverage through commercial, employer-sponsored, or government insurance - Your IMAAVY is prescribed by a U.S.-licensed physician for outpatient use - If you have Medicare Part D, you must spend more than 4% of your gross annual household income on prescription drugs ## Income Eligibility The program uses income thresholds based on family size and the Federal Poverty Level (FPL). While specific dollar amounts vary, the program is designed to assist patients with limited financial resources. Your household income will be verified during the application process using tax returns or other financial documentation. **Income Verification Requirements:** | Documentation Type | What to Provide | |---|---| | Primary income proof | Most recent Federal tax return (Form 1040 or 1040-SR) | | Puerto Rico residents | Form 482 or Form AS 6088.1 | | Insurance information | Front and back copies of all insurance cards | ## Insurance Requirements Contrary to what many patients believe, you do NOT need to be completely uninsured to qualify. The program assists patients with: - No insurance coverage - Commercial insurance that doesn't fully cover IMAAVY - Employer-sponsored insurance with high out-of-pocket costs - Government insurance (Medicaid, Medicare) with inadequate coverage **Special Medicare Part D Rule:** If you have Medicare Part D coverage, you may still qualify if you spend more than 4% of your gross annual household income on prescription drugs. You'll need to provide proof of your out-of-pocket costs, such as a pharmacy report or insurance Explanation of Benefits (EOB). ## How to Apply: Step-by-Step ### Step 1: Gather Your Documents Before starting your application, collect: - Your most recent Federal tax return (Form 1040 or 1040-SR) - Copies of front and back of all insurance cards (medical and pharmacy) - Your healthcare provider's information - Your prescription for IMAAVY ### Step 2: Complete the Enrollment Form Download the Patient Assistance Enrollment Form from JJPatientAssistance.com or request it by phone. The form has multiple sections: - Patient information (pages 1-2) - Healthcare provider information and signature (page 3) - Patient Consent Form (pages 4-5) - Patient Authorization Form (pages 6-7) **Important:** Your healthcare provider MUST complete and sign page 3 of the form, including prescription details. You cannot submit the application without this signature. ### Step 3: Have Your Doctor Sign Give your completed form to your healthcare provider's office. They need to: - Complete page 3 with prescription information - Sign and date the form - Return it to you If you're taking multiple J&J medications, your provider should complete a separate page 3 for each medicine. ### Step 4: Submit Your Application You have two options: **Online Submission:** - Visit JJPatientAssistance.com - Upload your completed form and supporting documents - You can also submit the Patient Consent Form and Authorization Form online at JJPatientAssistance.com/Consent and JJPatientAssistance.com/PA if you prefer **Fax Submission:** - Fax your completed form and all supporting documents to: 833-512-0497 - Keep a copy for your records ### Step 5: Wait for Approval The program will review your application and determine your eligibility. You'll receive updates on your enrollment status via mail or phone. ## Timeline and Medication Delivery **Processing Time:** While specific timelines aren't guaranteed, most applications are processed within 1-2 weeks of submission, though this may vary based on completeness of your application and verification of information. **Medication Delivery:** Once approved, your IMAAVY will be shipped directly to you or to your healthcare provider's office, depending on what works best for your situation. **Coverage Duration:** If approved, you'll receive your medication at no cost for up to one year. After one year, you'll need to reapply to continue receiving assistance. ## What Happens If Your Application Is Denied? If you don't qualify for the Johnson & Johnson Patient Assistance Program, you have other options: - Ask your healthcare provider about alternative medications that may be more affordable - Contact your insurance company to discuss coverage options or appeals - Visit MAT.org (Medicine Assistance Tool) to search for other financial assistance programs you may qualify for - Call the program at 833-742-0791 to ask if there are other J&J programs that might help ## Reauthorization and Renewal Your assistance is valid for one year from the date of approval. Before your year ends: - The program will contact you about reapplying - You'll need to submit updated financial information - If your circumstances have changed (income, insurance status), let the program know - If you're still eligible, your assistance will continue for another year ## Important Reminders - **Accuracy matters:** Incomplete or inaccurate applications cause delays. Double-check all information before submitting. - **Your doctor's signature is required:** You cannot proceed without your healthcare provider's signature on page 3. - **Keep copies:** Save copies of everything you submit. - **Update your information:** If your income, insurance, or address changes, notify the program immediately. ## Contact Information **Phone:** 833-742-0791 **Hours:** Monday through Friday, 8:00 AM – 8:00 PM ET **Website:** JJPatientAssistance.com or JNJwithMe.com ## Disclaimer This guide provides general information about the Johnson & Johnson Patient Assistance Program for IMAAVY. Program eligibility, requirements, and benefits may change. For the most current and complete information, visit JJPatientAssistance.com or call 833-742-0791. This program is subject to all applicable laws and regulations. Eligibility is determined by Johnson & Johnson based on individual circumstances.

Program information last verified: March 30, 2026