SIMPONI

Indicated For

Rheumatoid arthritis, Psoriatic arthritis, Ankylosing spondylitis, Ulcerative colitis

About This Medication

# Janssen Patient Assistance Program: How to Get SIMPONI at Low or No Cost ## About This Program The Janssen Patient Assistance Program helps eligible patients access SIMPONI (golimumab), a medication used to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and other inflammatory conditions. If you struggle to afford your SIMPONI prescription, this program may provide your medication at no cost for up to one year.[9] ## Who Qualifies You may be eligible for the Janssen Patient Assistance Program if you meet these basic requirements:[2] - You live in the United States or a U.S. territory - You are treated as an outpatient by a licensed U.S. healthcare provider - You have been prescribed SIMPONI by your doctor - You meet the income eligibility requirements for your household - You spend more than 4% of your gross annual household income on prescription drugs (if you have Medicare Part D) ## Income Eligibility The program has specific income thresholds that vary based on your household size and whether you have Medicare Part D coverage. While exact income limits are not publicly detailed in standard materials, the program uses federal poverty level guidelines to determine eligibility.[3] **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 at or below 150% of the Federal Poverty Level.[3] **For All Patients:** Your household income must fall within the program's eligibility range. Contact the program directly at **(833) 742-0791** to learn your specific income threshold based on household size. ## Insurance Requirements The Janssen Patient Assistance Program is available for patients with:[2] - Commercial insurance - Employer-sponsored coverage - Government insurance (Medicare, Medicaid) - No insurance (if you have checked eligibility for free or minimal-cost insurance options) The program helps when your existing insurance does not fully meet your medication needs. If you have Medicare Part D, you may need to provide documentation showing your out-of-pocket costs for the current year.[1] ## How to Apply: Step-by-Step **Step 1: Gather Your Documents** Before starting your application, collect the following:[1][2] - Copies of the front and back of all insurance cards (medical and pharmacy) - Your most recent Federal tax return (Form 1040 or 1040-SR) as proof of income - For Medicare Part D patients: A pharmacy report or Explanation of Benefits (EOB) statement showing your out-of-pocket prescription costs for the current year - Your healthcare provider's information **Step 2: Complete the Patient Enrollment Form** Download the Patient Assistance Enrollment Form from **www.newprograminfo.com** or the Janssen CarePath website. You and your caregiver should complete pages 2-5, including the Patient Authorization section.[2] Your healthcare provider will need to complete the remaining pages and sign the form to verify your prescription information.[3] **Step 3: Submit Your Application** You have two options:[1] - **Fax:** Send the completed form and supporting documents to **1-833-512-0497** - **Online Upload:** Visit the Janssen Patient Assistance Program document upload site at **account1.jnjwithme.com/patient-assistance/upload** **Step 4: Provide Complete Information** Ensure all required sections are completed and signed. Any missing information will delay processing your application.[1] ## Timeline and Delivery After you submit your application, Janssen will determine your insurance coverage, needs, and eligibility. You and your healthcare provider will receive updates on your enrollment status.[2] Once approved, SIMPONI will be shipped directly to you. The program provides medication cost assistance only and does not cover the costs of receiving treatment (such as infusion center fees).[10] ## Reauthorization Your enrollment in the program requires periodic reauthorization. You must notify the Janssen Support Program within 30 days if there are any changes in your income or health insurance coverage, including changes in your Medicare Part D enrollment status.[8] ## What If Your Application Is Denied? If you are not approved, ask Janssen for specific reasons. Common reasons for denial include: - Income exceeding program limits - Insurance coverage that adequately meets your needs - Not meeting other eligibility criteria You may reapply if your circumstances change, such as a decrease in household income or a change in insurance coverage. ## Getting Help For questions about the program or assistance completing your application, contact the Janssen Patient Support Program:[1] **Phone:** (833) 742-0791 **Hours:** Monday through Friday, 8:00 AM to 8:00 PM ET You can also visit **JJPatientAssistance.com** for more information. ## Important Disclaimer This guide provides general information about the Janssen Patient Assistance Program. Program details, eligibility requirements, and income thresholds may change. Always verify current requirements directly with Janssen by calling (833) 742-0791 or visiting their official website. This program is not insurance and does not replace your health coverage. Consult your healthcare provider about whether SIMPONI is appropriate for your condition.

Program information last verified: March 30, 2026