Simponi Aria

Indicated For

Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis

About This Medication

# Janssen Patient Assistance Program: How to Get SIMPONI ARIA at Low or No Cost ## About This Program The Janssen Patient Assistance Program helps eligible patients access SIMPONI ARIA (golimumab), a biologic medication used to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and other inflammatory conditions. If you struggle to afford your medication, this program may provide SIMPONI ARIA at no cost for up to one year.[8] ## Who Qualifies You may be eligible for this program if you meet all of the following criteria:[3] - 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 SIMPONI ARIA by your doctor - You meet the income eligibility requirements for your specific medication - You spend more than 4% of your gross annual household income on prescription drugs (this requirement applies to Medicare Part D patients only)[2] ## Income Eligibility The Janssen Patient Assistance Program uses income-based eligibility criteria, though specific income thresholds are not publicly listed in standard materials. Eligibility is determined on a case-by-case basis during your application review. For Medicare Part D patients, you must demonstrate that you are not eligible for the Low-Income Subsidy (LIS), which applies to patients whose income is 150% or less of the Federal Poverty Level.[2] To learn your specific income eligibility requirements, contact the program directly at **(833) 742-0791**, Monday through Friday, 8:00 AM to 8:00 PM ET.[1] ## Insurance Requirements You may qualify if you:[3] - Have no insurance and have checked eligibility for all available free or minimal-cost insurance options - Have commercial, employer-sponsored, or government coverage that does not fully meet your medication needs - Are enrolled in Medicare Part D and meet additional requirements **Medicare Part D Patients:** You must submit a pharmacy report or an Explanation of Benefits (EOB) statement from your insurer showing your out-of-pocket costs for the current year.[1] ## Step-by-Step Application Process ### Step 1: Gather Required Documents Before starting your application, collect the following:[1][3] - **Proof of Income:** A 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.) - **Prescription Information:** Your SIMPONI ARIA prescription from your healthcare provider - **Medicare Part D Patients Only:** A pharmacy report or EOB statement showing your out-of-pocket prescription drug costs for the current year ### Step 2: Complete the Patient Enrollment Form Download the Patient Assistance Enrollment Form and complete pages 2-5, including the Patient Authorization section.[3] You or your caregiver should fill out your personal information, including: - Full name and date of birth - Contact information (phone and email) - Current address - Insurance details - Prescription information You can also sign the Patient Authorization Form online at **JanssenPatientAssistance.com/PA** if you prefer not to print and sign a paper form. If you have already completed a Johnson & Johnson Patient Support Program Patient Authorization Form, you do not need to sign a new one.[1] ### Step 3: Have Your Healthcare Provider Complete the Form Your doctor must complete and sign the provider section of the enrollment form (page 3 or later, depending on the form version). Complete a separate copy of the provider page for each medication if you are applying for multiple Janssen products.[1] ### Step 4: Submit Your Application You have two options for submission:[1] - **Fax:** Send your completed enrollment form and all supporting documents to **1-833-512-0497** - **Online Upload:** Visit the Janssen Patient Assistance Program document upload site at **account1.jnjwithme.com/patient-assistance** to upload your completed form and documents Ensure all required information is included with your initial submission to avoid processing delays.[1] ### Step 5: Await Eligibility Determination The Janssen Patient Assistance Program will review your application, determine your insurance coverage and needs, and assess your eligibility. You and your healthcare provider will receive updates on your enrollment status.[3] ## Timeline and Medication Delivery The program does not publicly specify an exact processing timeline. However, submitting a complete application with all required documents will help expedite your review.[1] Once approved, SIMPONI ARIA will be shipped to you or your physician's office, depending on your preference and the program's standard procedures.[7] ## What Happens If Your Application Is Denied If you do not qualify for the Janssen Patient Assistance Program, ask your healthcare provider about: - Other manufacturer assistance programs - State pharmaceutical assistance programs - Non-profit organizations that help with medication costs - Clinical trials that may provide free medication - Negotiating a payment plan with your pharmacy or healthcare provider You can also contact the program at **(833) 742-0791** to discuss your specific situation and explore alternative options. ## Reauthorization and Program Changes You must notify the Janssen Patient Assistance Program within 30 days if there are any changes in your income or health insurance coverage.[9] This includes changes in your eligibility for Medicare or enrollment in Medicare Part D. The program may require you to reauthorize your participation periodically to confirm you still meet eligibility requirements. You may end your participation in the program at any time by calling **(833) 742-0791**, Monday through Friday, 8:00 AM to 8:00 PM ET.[3] ## Getting Help For questions about the application process or the program, contact the Janssen Patient Assistance Program: - **Phone:** (833) 742-0791 - **Hours:** Monday through Friday, 8:00 AM to 8:00 PM ET - **Online:** Visit **JanssenPatientAssistance.com/PA** for more information ## Important Disclaimer This guide provides general information about the Janssen Patient Assistance Program for SIMPONI ARIA. Program eligibility, requirements, and benefits may change. Always verify current program details by contacting Janssen directly or visiting their official website. This information is not a guarantee of program enrollment or medication provision. Your healthcare provider should be consulted regarding your treatment options and financial assistance eligibility.

Program information last verified: March 30, 2026