Iquix

Indicated For

Corneal ulcer, bacterial eye infection

About This Medication

# Janssen Ortho Patient Assistance Foundation: How to Get Iquix at Low or No Cost ## About This Program The Janssen Ortho Patient Assistance Foundation offers prescription assistance for eligible patients who cannot afford their medications. If you have been prescribed Iquix (levofloxacin ophthalmic solution) for a bacterial eye infection, this program may help you access your medication at no cost or significantly reduced cost. ## Who Qualifies You may be eligible for assistance if you meet all of the following criteria[2]: - You live in the United States or a U.S. territory - You are treated as an outpatient by a healthcare provider licensed in the U.S. - You have been prescribed an eligible Janssen medication (including Iquix) - You meet the income eligibility requirements for your specific medication - You are uninsured or underinsured - For Medicare Part D patients: You spend more than 4% of your gross annual household income on prescription drugs ## About Iquix (Levofloxacin Ophthalmic Solution) Iquix is a fluoroquinolone antibiotic eye drop used to treat bacterial conjunctivitis and other bacterial eye infections. It works by stopping the growth of bacteria. This medication is typically prescribed for short-term use during acute infections. ## Income Eligibility While specific income thresholds for Iquix are not detailed in available program documentation, the Janssen Ortho Patient Assistance Foundation evaluates eligibility based on your household income and financial need. The program is designed to assist patients who cannot afford their medications due to financial constraints. **To determine if you qualify, you will need to provide:** - Your most recent Federal tax return (Form 1040 or 1040-SR) - Information about your household size and composition - Details about your current insurance coverage (if any) The program will review your financial situation and determine your eligibility during the application process. ## Insurance Requirements This program is designed for **uninsured or underinsured patients**[2]. If you have insurance, you may still qualify if: - Your insurance does not cover Iquix - Your out-of-pocket costs are prohibitively high - You are a Medicare Part D patient spending more than 4% of your gross annual household income on prescription drugs You will need to provide copies of the front and back of all insurance cards (medical, pharmacy, etc.) as part of your application[2]. ## How to Apply: Step-by-Step ### Step 1: Gather Required Documents Before starting your application, collect the following[2][3]: - Your most recent Federal tax return (1040 or 1040-SR) - Copies of front and back of all insurance cards (if applicable) - Your healthcare provider's information - Your prescription for Iquix - Proof of income (if not using tax return) ### Step 2: Complete the Patient Enrollment Form Download the Patient Assistance Enrollment Form from the program website or request it from your healthcare provider[3]. You or your caregiver should complete pages 2-5, including the Patient Authorization section[2]. The form requires: - Your personal information (name, date of birth, address, phone number) - Your financial information (household income, family size) - Your insurance information - Your prescription details - Your authorization for the program to share health information with your healthcare providers and insurers ### Step 3: Have Your Healthcare Provider Complete Their Section Your healthcare provider must complete the remaining pages of the enrollment form, starting on page 6[2]. This includes: - Verification of your Iquix prescription - Confirmation that you are being treated as an outpatient - Their contact information and signature Your provider cannot charge you any fee for completing this enrollment[3]. ### Step 4: Submit Your Application Submit your completed form and supporting documents by: - **Faxing** to: 1-833-512-0497[5] - **Mailing** to: Janssen Ortho Patient Assistance Foundation, PO Box 221857, Charlotte, NC 28222-1857[3] Include all required supporting documents with your submission. Missing information will cause delays in processing[5]. ### Step 5: Receive Your Eligibility Determination The program will review your application and determine your insurance coverage, needs, and eligibility. You and your healthcare provider will receive updates on your enrollment status[2]. ## Timeline and Delivery While specific processing timelines are not detailed in available program documentation, you should expect: - **Application review period**: Several business days to weeks, depending on completeness of your submission - **Notification**: You will receive written confirmation of your eligibility status - **Medication delivery**: Once approved, your medication will be provided through the program To expedite processing, ensure all required information and supporting documents are included with your initial submission[5]. ## Reauthorization Your assistance is not permanent. You must notify the Janssen Ortho Patient Assistance Foundation within 30 days if there are any changes in your eligibility status, including[3]: - Changes in your income - Changes in your health insurance coverage - Changes in your Medicare enrollment status or eligibility - Changes in your age or disability status You may need to reapply or reauthorize your assistance periodically to continue receiving support. ## What If Your Application Is Denied? If you are not eligible for the Janssen Ortho Patient Assistance Foundation program, consider these alternatives: - **Contact your healthcare provider** about generic alternatives or lower-cost options - **Ask about manufacturer coupons** or discount programs - **Check with local community health centers** for reduced-cost care - **Explore other patient assistance programs** through organizations like NeedyMeds or Patient Advocate Foundation - **Contact Janssen directly** at 1-800-652-6227 to discuss other support options ## Important Disclaimer This guide provides general information about the Janssen Ortho Patient Assistance Foundation program. Program details, eligibility requirements, and procedures may change. For the most current and accurate information, contact the program directly at 1-800-652-6227 or visit the official program website. Always work with your healthcare provider when applying for patient assistance programs. This information is not a guarantee of eligibility or assistance.

Program information last verified: March 30, 2026