Coding & Billing
- Access & Reimbursement GuideA comprehensive summary of important medication information including uses, Important Safety Information, access, and reimbursement.
- Benefits Investigation FormA way to find out if RYBREVANT® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies.
- Business Associate AgreementComplete a Business Associate Agreement for your practice only once. No individual patient authorizations are required.
- Coding & Billing Guide
- Exception Considerations ChecklistA guide to submitting a formulary exception request.
Exception Considerations Checklist (en español)
- FDA Approval Letter for RYBREVANT®A link to the FDA's approval letter to Janssen Pharmaceuticals.
- Janssen CarePath Resource GuideA comprehensive summary of support tools for your office to help patients start and stay on treatment.
- Letter of ExceptionA template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary.
- Letter of Medical NecessityA template that you can fill out and submit to a patient’s health insurance provider. You may use it to explain why RYBREVANT® is medically necessary for your patient.
- Patient Account OverviewDownload this summary of Janssen CarePath resources for your patients.
- Patient Affordability OptionsDiscover options that can make RYBREVANT® more affordable for your patients.
- Patient Authorization FormIndividual patient form for offices without a Business Associate Agreement.
Patient Authorization Form (en español)
- Patient Authorization Form (en español)Individual patient form for offices without a Business Associate Agreement.
- Prior Authorization Considerations ChecklistA checklist to guide you through the prior authorization process.
Prior Authorization Considerations Checklist (en español)
- Savings Program (Overview)Eligible patients using commercial or private insurance can save on out-of-pocket costs for RYBREVANT®.
- Savings Program Assignment of Benefits FormA form the patient can submit that allows Janssen CarePath Savings Program to reimburse the provider directly.
- Verification of Benefits Guide (Medical)A guide to understanding the Verification of Benefits for your patient’s medical benefits.
- Verification of Benefits Guide (Pharmacy)A guide to understanding the Verification of Benefits for your patient’s pharmacy benefits.
Coding & Billing
The RYBREVANT® permanent J-Code is now available, effective January 1, 2022. Please refer to the resources below for additional details.