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Pre-Registration Form | Janssen Select for XARELTO® (rivaroxaban)

We can tell you if and when Janssen Select becomes your most affordable option.

Everyone enters their coverage gap at a different time of the year. Take out the guesswork.

Simply enter your information below to get notified about when you are approaching your coverage gap. By signing up, you'll have the convenience of receiving notifications about your eligibility, your upcoming coverage gap, how to enroll into Janssen Select when eligible, and information on other support programs that may help.

The information you provide may be used by Janssen Pharmaceuticals, Inc., our affiliates, and our service providers to send you information about the Janssen Select program, including notifications about your eligibility, your upcoming coverage gap, and instructions on how to enroll in Janssen Select when eligible, as well as information on other support programs that may help. In order to personalize the information you receive, the information you provide may be combined with information received about you from other sources, as described in our Privacy Policy. If you choose to enroll into the Janssen Select program, the information you provide may be used at the time of enrollment to verify your identity and simplify the enrollment/registration process. Our Privacy Policy further governs the information you provide.

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