Razadyne ER

Indicated For

Alzheimer's disease mild to moderate

About This Medication

# Johnson & Johnson Patient Assistance Foundation Patient Guide: How to Get Razadyne ER at Low or No Cost ## About This Program The Johnson & Johnson Patient Assistance Foundation Patient Assistance Program helps eligible patients receive Razadyne ER (galantamine HBr) at no cost for up to one year. This program is designed to ensure that financial constraints do not prevent you from accessing the medication your doctor has prescribed. ## Who Can Qualify? You may be eligible for this program if you meet the following requirements: - **Live in the United States or a U.S. territory** - **Have a valid prescription** for Razadyne ER from a U.S.-licensed physician for outpatient use - **Meet income guidelines** based on your household size (specific thresholds vary and will be reviewed during your application) - **Meet insurance requirements** (see Insurance Eligibility section below) ## About Razadyne ER Razadyne ER (galantamine HBr) is a medication prescribed to treat cognitive symptoms associated with mild to moderate Alzheimer's disease. It works by increasing the levels of certain chemicals in the brain that help with memory and thinking. Your doctor has determined that this medication is appropriate for your medical condition. ## Income Eligibility Income guidelines for this program vary based on your household size. The program uses federal poverty level guidelines to determine eligibility. During your application, you will need to provide proof of your household income. | Household Size | Income Consideration | |---|---| | 1 person | Individual income threshold applies | | 2 people | Couple income threshold applies | | 3 people | Family of 3 threshold applies | | 4+ people | Family of 4+ threshold applies | *Note: Specific income thresholds will be provided when you contact the program or begin your application. Income guidelines are updated periodically.* ## Insurance Requirements This program is available to patients with various insurance situations: - **Uninsured patients** are eligible - **Commercially insured patients** may be eligible - **Employer-sponsored insurance** holders may be eligible - **Medicare and Medicaid beneficiaries** may be eligible, but specific rules apply **Important Medicare Note:** If you have Medicare Part D coverage, you may still qualify if you are spending more than 4% of your gross annual household income on prescription drugs. You will need to demonstrate this spending level during your application. **Review Program Rules:** Because insurance requirements can be complex, it is important to contact the program directly to confirm your specific insurance situation qualifies. ## Step-by-Step Application Process ### Step 1: Gather Your Information Before you begin, collect the following: - Your insurance information (copies of front and back of all insurance cards) - Your healthcare provider's contact information - Proof of income (most recent Federal tax return, Form 1040 or 1040-SR) - Your personal information (name, date of birth, address, phone number) ### Step 2: Contact the Program Reach out to the Johnson & Johnson Patient Assistance Program: - **Phone:** (800) 652-6227 - **Hours:** Monday through Friday, 8:00 AM – 8:00 PM ET - **What to say:** Tell them you need assistance with Razadyne ER and ask for an enrollment form ### Step 3: Complete the Enrollment Form You will receive a Patient Assistance Enrollment Form. Complete all sections carefully: - Fill in all required fields (marked with an asterisk) - Provide your personal information - List your insurance details - Include your income information - Sign and date the form on page 2 - Review and agree to the Patient Authorization Form and Terms of Participation (pages 4-7) ### Step 4: Have Your Doctor Complete the Form Your healthcare provider must complete and sign page 3 of the enrollment form. This confirms your prescription for Razadyne ER and verifies that you are an outpatient. If you take multiple medications, your doctor will need to complete a separate page 3 for each medication. ### Step 5: Submit Your Application Submit your completed form and supporting documents by: - **Faxing** to: 1-833-512-0497 - **Or mailing** to the address provided by the program Include copies of: - Your insurance card(s) (front and back) - Your most recent Federal tax return - Any other supporting documents requested **Important:** Incomplete applications will cause delays. Make sure all required information is provided. ### Step 6: Wait for Approval The program will review your application and determine your eligibility. This typically takes approximately 4 weeks. You will be contacted with the decision. ## Timeline and Medication Delivery - **Application Processing:** Approximately 4 weeks from submission - **Approval Notification:** You will be contacted by phone or mail - **Medication Delivery:** Once approved, your medication will be dispensed through a pharmacy - **Coverage Duration:** Up to one year of medication at no cost ## What If Your Application Is Denied? If you are not approved for the Johnson & Johnson program, ask the program about: - Whether you may reapply if your circumstances change - Alternative assistance programs for your medication - Other resources available to help you afford Razadyne ER - Whether a patient advocacy organization can provide additional support ## Important Limitations This program provides medication cost assistance only. It does not cover: - The cost of doctor visits or medical appointments - Laboratory tests or diagnostic procedures - Other healthcare services related to your treatment You will still be responsible for these costs through your regular insurance or out-of-pocket. ## Questions or Need Help? If you have questions about the application process or need assistance completing your form: - **Call:** (800) 652-6227 - **Hours:** Monday through Friday, 8:00 AM – 8:00 PM ET - **What they can help with:** Application questions, eligibility clarification, form completion, status updates ## Important Disclaimer This guide provides general information about the Johnson & Johnson Patient Assistance Foundation Patient Assistance Program for Razadyne ER. Program eligibility, requirements, and benefits may change at any time without notice. The information provided is current as of the date of this guide but should be verified with the program directly. Always consult with your healthcare provider about your medication and treatment plan. This guide is not a substitute for official program documentation or professional medical advice.

Program information last verified: March 30, 2026