Benefits Investigation Support

Benefits Investigation Support

Need help? Call 877-CarePath (877-227-3728) Monday-Friday, 8:00 AM-8:00 PM ET

Access Support to Help Navigate Payer Processes

Janssen CarePath provides benefits information that may help your patients get the Janssen medication you may be considering for them. Contact us directly and get started today.

  • Investigation of patient eligibility and coverage:
    • Patient-specific benefits
    • Requirements for prior authorization process
    • Prior authorization support and status monitoring
  • Convenient electronic portal for online benefits investigations
  • Benefits summary available for physicians and staff
  • Information on payer policies and coverage for Janssen products
  • Information on the appeals process for administrative denials
  • Billing and coding information

Janssen CarePath Provider Portal

Verifying your patients' benefits is easy with the Provider Portal. The Janssen CarePath Provider Portal gives you 24-hour online access to request and review benefits investigations, provide prior authorization support and status monitoring, request exceptions and appeals research, and enroll patients in the Janssen CarePath Savings Program.

To get started

Create a Provider Portal account at JanssenCarePathPortal.com

  • Complete required information, include your practice locations, add administrators and staff to your site, and set communication preferences

Complete the Business Associate Agreement (BAA) for your practice (one time only)

  • The completed BAA allows you to use the Provider Portal without requiring individual patient authorization
    • You can execute the BAA within the Portal and receive immediate verification and access to the Portal, or
    • You can download the BAA at JanssenCarePath.com and upload the signed document via the Portal or fax to the number provided on the form

OR

Secure patient authorization (for each patient)

  • Invite each patient to create an online account at MyJanssenCarePath.com to secure patient authorization, or
  • You can download the Patient Authorization Form at JanssenCarePath.com and upload the signed document via the Portal or fax to the number provided on the form

We cannot accept any information without an executed BAA or Patient Authorization on file.

If you have a BAA or Patient Authorization on file with us, please Sign Up for the Provider Portal at JanssenCarePathPortal.com.

Registered or returning Provider Portal users, Log In here.

Benefits Investigation

Download the Prescription Enrollment Form, complete, and submit to us via fax.*

TREMFYA® Prescription Enrollment Form (PEF)

*Janssen CarePath cannot accept any patient information without an executed BAA or individual patient authorization.

Letter of Medical Necessity

Submit a letter to support the medical necessity of treatment with TREMFYA® either with the initial claim or when requesting reconsideration of a denied claim. Click here for the sample letter (editable).

Prior Authorization Assistance

On the phone or online, our Prior Authorization (PA) Assistance includes:

  • Researching patient’s health plan for PA requirements
  • Providing payer-specific PA form
  • Monitoring status of the PA submission
  • Notifying your office 30 days before PA expiration

We do not fill out any information that requires the medical judgment of the prescriber, and only the prescriber can determine whether to pursue a prior authorization.

Online resource for PA support is available at JanssenCarePathPortal.com.

Uniform Prescription Drug Prior Authorization Request Form & Notification Requirements for Health Plans

Some health plans in select states must use their state's uniform prior authorization request form. Please contact Janssen CarePath at 877-CarePath (877-227-3728) for assistance in obtaining prior authorization forms.

Uniform Prior Authorization Information for Select States

Patient insurance benefits investigation and other Janssen CarePath program offerings are provided by third-party service providers for Janssen CarePath, under contract with Johnson & Johnson Health Care Systems Inc. on behalf of Janssen Pharmaceuticals, Inc., Janssen Biotech, Inc., and Janssen Products, LP (Janssen). Janssen CarePath is not available to patients participating in the Patient Assistance Program offered by Johnson & Johnson Patient Assistance Foundation. The availability of information and assistance may vary based on the Janssen medication, geography and other program differences. Janssen CarePath assists healthcare providers (HCPs) in the determination of whether treatment could be covered by the applicable third-party payer based on coverage guidelines provided by the payer, and patient information provided by the HCP under appropriate authorization following the provider's exclusive determination of medical necessity. This information and assistance are made available as a convenience to patients, and there is no requirement that patients or HCPs use any Janssen product in exchange for this information or assistance. Janssen assumes no responsibility for and does not guarantee the quality, scope, or availability of the information and assistance provided. The third-party service providers, not Janssen, are responsible for the information and assistance provided under this program. Each HCP and patient is responsible for verifying or confirming any information provided. All claims and other submissions to payers should be in compliance with all applicable requirements.

Indication

TREMFYA® is indicated for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

TREMFYA® is administered as a 100 mg subcutaneous injection once every 8 weeks, after starter doses at weeks 0 and 4. TREMFYA® is intended for use under the guidance and supervision of a physician. Patients may self-inject with TREMFYA® after physician approval and proper training.

 

Important Safety Information For TREMFYA®

Important Safety Information

CONTRAINDICATIONS
TREMFYA® is contraindicated in patients with a history of serious hypersensitivity reaction to guselkumab or to any of the excipients.

WARNINGS AND PRECAUTIONS
Infections
TREMFYA® may increase the risk of infection. Treatment with TREMFYA® should not be initiated in patients with a clinically important active infection until the infection resolves or is adequately treated.

Consider the risks and benefits of treatment prior to prescribing TREMFYA® in patients with a chronic infection or a history of recurrent infection. Instruct patients receiving TREMFYA® to seek medical help if signs or symptoms of clinically important chronic or acute infection occur. If a patient develops a clinically important or serious infection, or is not responding to standard therapy, closely monitor and discontinue TREMFYA® until the infection resolves.

Pre-Treatment Evaluation for Tuberculosis (TB)
Evaluate patients for TB infection prior to initiating treatment with TREMFYA®. Initiate treatment of latent TB prior to administering TREMFYA®. Monitor patients for signs and symptoms of active TB during and after TREMFYA® treatment. Do not administer TREMFYA® to patients with active TB infection.

Hypersensitivity Reactions
Serious hypersensitivity reactions have been reported with postmarket use of TREMFYA®, some cases required hospitalization. If a serious hypersensitivity reaction occurs, discontinue TREMFYA® and initiate appropriate therapy.

Immunizations
Prior to initiating TREMFYA®, consider completion of all age-appropriate immunizations according to current immunization guidelines. Avoid use of live vaccines in patients treated with TREMFYA®.

ADVERSE REACTIONS
Most common (≥1%) adverse reactions associated with TREMFYA® include upper respiratory infections, headache, injection site reactions, arthralgia, diarrhea, gastroenteritis, tinea infections, and herpes simplex infections.

Please read the full Prescribing Information and Medication Guide for TREMFYA®. Provide the Medication Guide to your patients and encourage discussion.

cp-82625v1