SYMTUZA

Indicated For

HIV-1 infection

About This Medication

# Johnson & Johnson Patient Assistance Program: How to Get SYMTUZA at Low or No Cost ## About SYMTUZA SYMTUZA (darunavir/cobicistat/emtricitabine/tenofovir alafenamide) is a prescription medication used to treat HIV infection. It combines four active ingredients into a single tablet, making it a convenient once-daily treatment option for eligible patients. The Johnson & Johnson Patient Assistance Program helps patients access SYMTUZA when cost is a barrier to treatment. ## Who Qualifies for This Program? The Johnson & Johnson Patient Assistance Program uses a **needs-based eligibility approach**, meaning your qualification depends on your financial situation and insurance status rather than strict income cutoffs. You may be eligible if you: - Live in the United States or a U.S. territory[1] - Have a valid prescription from a U.S.-licensed physician for outpatient use[6] - Meet one of the insurance requirement categories (see below) - Demonstrate financial need based on your household income and expenses[6] ## Insurance Requirements The program is designed to help patients facing access and affordability challenges across different insurance situations[9]: | Insurance Status | Eligibility | |---|---| | **Uninsured** | Eligible if you have no prescription drug coverage[6] | | **Commercial Insurance** | Eligible if you have inadequate coverage or high out-of-pocket costs[8] | | **Medicare Part D** | Eligible if you spend **4% or more of your gross annual household income** on prescription drugs[3][6] | | **Medicaid/Government Coverage** | Eligible if you have inadequate coverage[8] | If you have Medicare Part D, you must also demonstrate that you are **not eligible for the Low-Income Subsidy (LIS)**, which applies to patients with income at or below 150% of the Federal Poverty Level[3]. ## Income Eligibility The program does not publish specific income thresholds. Instead, eligibility is determined on a **case-by-case basis** considering your household income, family size, and financial obligations[1][7]. During the application process, you'll provide financial documentation that helps determine whether you qualify. ## How to Apply ### Step 1: Gather Required Documents Before starting your application, collect the following[2][5]: - Your insurance information (copies of front and back of all insurance cards) - Proof of income (most recent Federal tax return: Form 1040 or 1040-SR) - Your healthcare provider's information - If you have Medicare Part D: a pharmacy report or EOB statement showing your out-of-pocket prescription costs for the current year[9] - For Puerto Rico residents: additional financial documentation ### Step 2: Complete the Enrollment Form You have two options for completing the Patient Assistance Enrollment Form[2][5]: **Online Application:** - Visit the enrollment portal at https://account.jnjwithme.com or https://portal.jnjwithme.com - Complete all sections on page 2 and sign - Review and agree to the Patient Authorization Form and Terms of Participation (pages 4-7) - Upload supporting documents - Submit online **Paper Application:** - Download the Patient Assistance Enrollment Form - Complete all sections and sign on page 2 - Have your healthcare provider complete and sign page 3 - Gather supporting documents - Fax the completed form and documents to **1-833-512-0497** ### Step 3: Healthcare Provider Signature Your doctor must complete and sign page 3 of the enrollment form, confirming your prescription for SYMTUZA[2][5]. If you need assistance with multiple medications, your provider should complete a separate page 3 for each medication. ### Step 4: Submit Your Application Submit your completed form and supporting documents either online or by fax. **Important:** Any missing required information will delay processing of your application[2][5]. ## Application Support If you need help completing the form or have questions about the program, contact the Johnson & Johnson Patient Assistance Program:[2][5] - **Phone:** 833-742-0791 - **Hours:** Monday through Friday, 8:00 AM – 8:00 PM ET - **Alternative:** You can also apply through Simplefill by calling (877) 386-0206, and their patient advocates will guide you through the entire process[6] ## Timeline and Medication Delivery While specific processing times are not publicly disclosed, the program will: - Review your application and determine your eligibility based on insurance coverage and financial need[3] - Provide eligibility determination letters to both you and your healthcare provider[8] - Ship your medication directly to you once approved[1][7] - Provide updates on your enrollment status to both you and your provider[3] If you apply through Simplefill, you'll receive a call from a patient advocate within 24 hours to discuss your medical, financial, and insurance information[6]. ## Program Benefits If approved, you may receive **SYMTUZA at no cost for up to one year**[1][7]. The program covers the medication cost only and does not cover costs associated with receiving treatment (such as doctor visits or lab work). ## Reauthorization and Renewals Your assistance is provided for up to one year. When it's time to renew, you'll need to reapply to continue receiving medication at no cost[1]. If you apply through Simplefill, they will handle your renewal process automatically if you still need assistance[6]. ## What If Your Application Is Denied? If you don't qualify for the Johnson & Johnson Patient Assistance Program, you have options: - Ask your healthcare provider about other patient assistance programs for SYMTUZA - Contact pharmaceutical patient assistance databases like RxAssist or NeedyMeds for alternative programs - Discuss generic or alternative HIV medications with your doctor - Ask your insurance company about appeals or coverage exceptions - Contact local HIV/AIDS organizations for additional financial assistance resources ## Important Notes - The program requires that your prescription be for **outpatient use only**[6] - Your personal information (name, address, phone, email, financial information, and prescription details) will be used by Johnson & Johnson and its service providers to determine eligibility and administer the program[5] - You can withdraw from the program at any time by calling 833-742-0791[5] - If your treatment plan changes and you need a different medication, notify the program so they can update your assistance ## Disclaimer This guide provides general information about the Johnson & Johnson Patient Assistance Program for SYMTUZA. Program details, eligibility requirements, and benefits may change. For the most current and accurate information, contact the program directly at 833-742-0791 or visit https://account.jnjwithme.com. Always consult with your healthcare provider about your treatment options and financial assistance eligibility.

Program information last verified: March 30, 2026