Helping Patients Afford STELARA®
- Benefits Investigation & Prescription Form - Dermatology & RheumatologyA way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies.
Benefits Investigation & Prescription Form - Dermatology & Rheumatology (en español para Puerto Rico) - Benefits Investigation & Prescription Form - Dermatology & Rheumatology (en español para Puerto Rico)A way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies. En español.
- Business Associate AgreementComplete a Business Associate Agreement for your practice only once. No individual patient authorizations are required.
- Delay & Denial Support Reverification GuideUse this guide to learn how to confirm your patient's eligibility for Delay & Denial Support/Janssen Link if they have previously been eligible.
- Enrollment & Prescription Form - GastroenterologyA way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies.
Enrollment & Prescription Form - Gastroenterology (en español para Puerto Rico) - Enrollment & Prescription Form - Gastroenterology (en español para Puerto Rico)A way to find out if STELARA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies. En español.
- Letter of Exception (Crohn’s Disease)A 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 Exception (Plaque Psoriasis)A 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 Exception (Psoriatic Arthritis)A 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 Exception (Ulcerative Colitis)A 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 STELARA® is medically necessary for your patient.
- Patient Affordability OptionsDiscover options that can make STELARA® 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.
- Prescribing Information & Medication Guide (en español)Product information for STELARA®. En español.
- Resource GuideA comprehensive summary of support tools for your office to help patients start and stay on treatment.
- Savings Program Additional Co-pay Support Form
- Savings Program Assignment of Benefits FormA form the patient can submit that allows Janssen CarePath to reimburse the provider directly.
- Savings Program Assignment of Benefits Form - AccumulatorA form the patient can submit that allows STELARA withMe to reimburse the provider directly.
- Savings Program EOB Clarification FormUse this form when the Explanation of Benefits (EOB) statement does not indicate that the patient received STELARA®.
- Savings Program OverviewEligible patients using commercial or private insurance can save on out-of-pocket costs for STELARA®.
- Savings Program Patient Enrollment FormFax or mail this completed form to enroll your patient in the Savings Program for STELARA®.
- Savings Program Rebate FormA form the patient can submit if the pharmacy isn’t able to process the Savings Program card or for a medical benefit rebate.
- Savings Program Rebate Form - Accumulator MedicalA rebate form that when submitted along with the Explanation of Benefits (EOB) requests a rebate check to be sent directly to the patient.
- Savings Program Rebate Form - Accumulator PharmacyA form that is submitted when the pharmacy can't process the
STELARA withMe Savings Program card or Virtual Payment Card. - Specialty Distributors for IV Infusion
- 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.

Helping Patients Afford STELARA®
Select your patient’s coverage status for relevant resources.
For Patients with Commercial or Private Insurance
There is a limit to savings each year. Program does not cover the cost to give patients their treatment.
Patients may participate without sharing their income information.
We provide cost support directly to patients through the STELARA withMe Savings Program. This benefit is intended to help eligible patients afford their out-of-pocket obligations as set by their health plans. The cost support is meant solely for patients—not health plans and/or their partners.
If your patients are having any difficulty accessing cost support through the STELARA withMe Savings Program, please have them contact us at 844-4withMe (844-494-8463).
- Sign Patients Up for the Savings Program and Get a Savings Card
- Sign Patients Up for the Savings Program and Get a Savings Card
- Manage Savings Program Transactions
- Requires Business Associate Agreement/Patient Authorizations
- Get Benefits Investigations
- Get Prior Authorization Support
- Create Medical Necessity and Exception Letters
- Request Exceptions and Appeals Information
- View Patient Dashboard
- Get Timely Notifications
- 24-hour Online Access to Your Account
Help Your Patients Manage Their Savings Program Benefits
The patient is responsible for submitting a rebate request to the STELARA withMe Savings Program or, at the patient’s direction, you may submit the rebate request on behalf of the patient. Confirm with your patient who will submit rebate requests to the Savings Program.
You may submit rebate requests via the Provider Portal or by fax or mail.
For prompt rebate payment to your patient, we recommend you:
- Submit the patient’s Explanation of Benefits (EOB) using your account on the Provider Portal
Directing Rebate to Treatment Site
Be sure to submit:
- Patient’s Explanation of Benefits (EOB)
- Savings Program Assignment of Benefits Form (AOB) from patient
- Copy of the Health Insurance Claim Form CMS-1500 (HICF) or Uniform Billing Form CMS-1450 (UB-04)
In addition to the STELARA withMe Savings Program, here are some independent programs that may be right for your patients.
Additional Affordability Support from Janssen
For Patients with Government Coverage
Even if your patients have government coverage like Medicare, we can identify programs that may help them afford their medications. Here are some independent programs that may be right for them.
Additional Affordability Support from Janssen
For Patients with No Insurance Coverage
If your patients need help with drug costs, we can identify programs that may help them afford their medications.
Here are some programs that are not offered by Janssen. Each program has its own eligibility rules.
Take a look and see which ones may be right for your patients.
Uninsured Patients May Be Eligible for Additional Support
There is a limit to savings each year. Program does not cover the cost to give patients their treatment.
Patients may participate without sharing their income information.
We provide cost support directly to patients through the STELARA withMe Savings Program. This benefit is intended to help eligible patients afford their out-of-pocket obligations as set by their health plans. The cost support is meant solely for patients—not health plans and/or their partners.
If your patients are having any difficulty accessing cost support through the STELARA withMe Savings Program, please have them contact us at 844-4withMe (844-494-8463).
- Sign Patients Up for the Savings Program and Get a Savings Card
- Sign Patients Up for the Savings Program and Get a Savings Card
- Manage Savings Program Transactions
- Requires Business Associate Agreement/Patient Authorizations
- Get Benefits Investigations
- Get Prior Authorization Support
- Create Medical Necessity and Exception Letters
- Request Exceptions and Appeals Information
- View Patient Dashboard
- Get Timely Notifications
- 24-hour Online Access to Your Account
Help Your Patients Manage Their Savings Program Benefits
The patient is responsible for submitting a rebate request to the STELARA withMe Savings Program or, at the patient’s direction, you may submit the rebate request on behalf of the patient. Confirm with your patient who will submit rebate requests to the Savings Program.
You may submit rebate requests via the Provider Portal or by fax or mail.
For prompt rebate payment to your patient, we recommend you:
- Submit the patient’s Explanation of Benefits (EOB) using your account on the Provider Portal
Directing Rebate to Treatment Site
Be sure to submit:
- Patient’s Explanation of Benefits (EOB)
- Savings Program Assignment of Benefits Form (AOB) from patient
- Copy of the Health Insurance Claim Form CMS-1500 (HICF) or Uniform Billing Form CMS-1450 (UB-04)