Intelence

Indicated For

HIV-1

About This Medication

# J&J withMe Patient Assistance Program: How to Get Intelence at Low or No Cost ## About This Program The **J&J withMe Patient Assistance Program**, administered by Janssen (a Johnson & Johnson company), helps eligible patients access **Intelence (etravirine)** at reduced or no cost. This program is designed for patients who struggle with medication affordability, whether they are uninsured, underinsured, or facing high out-of-pocket costs.[1][2] ## Who Qualifies? You may be eligible for the J&J withMe Patient Assistance Program if you: - Have been prescribed Intelence by a licensed healthcare provider[1][2] - Meet income and other eligibility requirements[1][2] - Are a U.S. resident[3] - Have no insurance, insufficient insurance coverage, or high out-of-pocket costs[9] The program serves patients regardless of insurance status, making it accessible to both uninsured and insured individuals who need financial support.[9] ## About Intelence (Etravirine) Intelence is an antiretroviral medication used to treat HIV infection. It works by blocking the reverse transcriptase enzyme that HIV uses to replicate. Intelence is typically prescribed as part of a combination antiretroviral therapy regimen and is used in treatment-experienced patients with HIV-1 infection.[1] ## Income Eligibility While specific income thresholds are not publicly detailed in program materials, eligibility is determined based on a combination of factors including your household income, insurance status, and financial need.[1][2] The program evaluates each application individually to determine if you qualify for assistance. To help assess your potential eligibility, gather information about: - Your household size and annual income - Current insurance coverage (if any) - Monthly out-of-pocket medication costs - Other financial obligations ## Insurance Requirements The J&J withMe program works with patients in various insurance situations:[9] | Insurance Status | Eligibility | Notes | |---|---|---| | Uninsured | Eligible | Program may provide medication at no cost | | Commercially Insured | Eligible | Program evaluates coverage gaps and out-of-pocket costs | | Medicare/Medicaid | Eligible | Program coordinates with government insurance | | Underinsured | Eligible | Program assists with copays, coinsurance, and deductibles | If you have insurance, J&J withMe will verify your benefits and determine what portion of your medication costs they can help cover.[10] ## Step-by-Step Application Process ### Step 1: Gather Required Documents Before starting your application, collect the following:[3][4] - **Patient Assistance Enrollment Form** (available for download from the program website) - **Proof of income**: Copy of your most recent Federal tax return (Form 1040 or 1040-SR) - **Insurance information**: Copies of the front and back of all insurance cards (medical, pharmacy, etc.) - **Healthcare provider information**: Your doctor's name, contact information, and clinic details - **Prescription information**: Details about your Intelence prescription For Puerto Rico residents, additional financial documentation may be required.[4] ### Step 2: Complete the Patient Assistance Enrollment Form The enrollment form has multiple sections:[3][4] 1. **Patient Information**: Your name, contact information, and personal details 2. **Insurance Information**: Details about your current coverage 3. **Healthcare Provider Section**: Your doctor must complete and sign this section (one copy per medication) 4. **Patient Authorization Form**: You must read, understand, and sign this form, which gives J&J withMe permission to use your medical information 5. **Terms of Participation**: Review and sign to confirm you agree to program terms Alternatively, you can complete the Patient Authorization Form online at JJPatientAssistance.com/PA or JanssenPatientAssistance.com/PA without printing.[3][4] ### Step 3: Have Your Healthcare Provider Complete Their Section Your doctor must complete and sign page 3 of the enrollment form, confirming your Intelence prescription and medical need. If you're applying for multiple J&J medications, your provider needs to complete a separate copy of page 3 for each medication.[3][4] ### Step 4: Submit Your Application You have two submission options:[3][6] **Option A: Fax Submission** - Fax your completed form and supporting documents to: **1-833-512-0497**[3] **Option B: Online Upload** - Visit the Document Site at account1.jnjwithme.com/patient-assistance/upload[8] - Download blank forms if needed - Upload your completed enrollment form and supporting documents ### Step 5: Follow Up If you have questions during the application process, call **833-742-0791**, Monday through Friday, 8:00 AM to 8:00 PM ET.[3] ## Timeline and Delivery **Processing Time**: While specific processing timelines are not detailed in program materials, J&J withMe aims to process applications promptly. Incomplete applications may experience delays, so ensure all required information and documents are included with your initial submission.[3] **Delivery Methods**: Once approved, Intelence can be delivered:[1] - Directly to your home - To your healthcare provider's office - To a specialty pharmacy (if applicable) **Duration of Support**: Eligible patients may receive Intelence at no cost for up to one year, after which reauthorization may be required.[1][2] ## What Happens If Your Application Is Denied If you don't qualify for the J&J withMe Patient Assistance Program, the program can refer you to independent foundations that provide financial support to patients in need.[9] Additionally, J&J withMe can help identify other access solutions and cost support options available to you. If denied, ask about: - Referrals to other patient assistance organizations - Manufacturer discount programs - State pharmaceutical assistance programs - Community health center resources ## Reauthorization Since assistance is typically provided for up to one year, you will need to reauthorize your enrollment to continue receiving support.[1][2] J&J withMe will contact you before your current authorization expires to guide you through the reauthorization process. Be prepared to provide updated financial and insurance information. ## Important Reminders - **Incomplete applications cause delays**: Provide all required information and documents with your initial submission.[3] - **Your doctor's signature is essential**: The program cannot process enrollment without your healthcare provider's completed and signed section.[6] - **Keep your information current**: Notify J&J withMe of any changes to your insurance, income, or contact information. - **This is not insurance**: The J&J withMe program is a manufacturer assistance program, not health insurance. ## Contact Information For questions about the J&J withMe Patient Assistance Program: - **Phone**: 833-742-0791 (Monday–Friday, 8:00 AM–8:00 PM ET) - **General J&J withMe inquiries**: 877-227-3728 (Monday–Friday, 8:00 AM–8:00 PM ET) - **Website**: JNJwithMe.com - **Fax**: 1-833-512-0497 ## Disclaimer This guide provides general information about the J&J withMe Patient Assistance Program based on publicly available program materials. Eligibility requirements, income thresholds, and program terms may change. For the most current and complete information, visit JNJwithMe.com or contact the program directly. This guide is not a guarantee of eligibility or assistance. Always consult with your healthcare provider about your treatment options and financial assistance programs.

Program information last verified: March 30, 2026