Medicaid
- 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)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 Assignment of Benefits FormA form the patient can submit that allows Janssen CarePath 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 Janssen CarePath Savings Program 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.

Medicaid
Medicaid provides free or low-cost health coverage to Americans with limited income and resources. Low-income adults, children, pregnant women, elderly adults, and people with disabilities may be eligible. Medicaid is run by each state. The program is funded jointly by the states and the federal government. Coverage for STELARA® may depend on the indication, along with other factors. Since information varies by state, we recommend contacting the state directly or reviewing its website.
We can help Medicaid patients with Benefits Investigations and Prior Authorization support.
Visit your state’s Medicaid page for more coverage information. You can use the menu below to find contact details for your state.