Commercial Payer Information

Commercial Payer Information

Payers create their own policies with regard to product coverage. Since information varies by payer, it is important to contact the payer directly or consult its Web site to obtain product-specific coverage information.

Commercial payers each have their own forms and requirements for requesting prior authorization of a prescription drug. Below are links to payer Web sites where you may obtain more information on pharmacy policies and the approval process, including direct links to drug prior authorization forms and links to formularies. It is important to contact the payer directly or consult its Web site to obtain product-specific information.

Third-party reimbursement is affected by many factors. The content provided is for informational purposes only and is not intended to provide reimbursement or legal advice and does not promise or guarantee coverage, levels of reimbursement, payment, or charge. Similarly, all CPT®* and HCPCS codes are supplied for informational purposes only and represent no promise or guarantee that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payer. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current as of the issue date of this document, the information may not be as current or comprehensive when you view it. We strongly recommend that you consult with your payer organization(s) for local or actual coverage and reimbursement policies and with your internal reimbursement specialist for any reimbursement or billing questions.

*CPT® copyright 2016 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

Janssen CarePath does not endorse and is not responsible for the content on any of the Web sites listed below, or the services provided by these organizations. Clicking on any of the links below will take you to a Web site to which our privacy policy does not apply. We encourage you to read the privacy policy of every Web site you visit.

Payer Prior Authorization Information
Aetna Pharmacy Clinical Policy Bulletins and Prior Authorization
Arkansas Blue Cross and Blue Shield Prior Authorization Request Form
Blue Cross and Blue Shield of Alabama Specialty Pharmacy Form
Blue Cross and Blue Shield of Florida/Florida Blue Medication Guides
Quantity Limit Request Form
Specialty Pharmacy Request Form
Blue Cross and Blue Shield of Illinois Prior Authorization and Step Therapy Programs
Blue Cross and Blue Shield of Kansas Prescription Drugs
Prior Authorization
Blue Cross and Blue Shield of Minnesota Minnesota Uniform Form for PA Requests and Formulary Exceptions
Blue Cross and Blue Shield of Montana Prior Authorization
Blue Cross and Blue Shield of Nebraska Policies & Forms: Pre-Authorization Forms
Blue Cross and Blue Shield of New Mexico Prior Authorization and Step Therapy Programs
Blue Cross and Blue Shield of North Carolina Prior Review and Limitations
Blue Cross and Blue Shield of Oklahoma Prior Authorization and Step Therapy Programs
Blue Cross Blue Shield of Arizona Prior Authorization Guidelines
Blue Cross Blue Shield of Wyoming Pharmacy Guide & Forms
Blue Cross of Idaho Provider Prior Authorization Requirements: Pharmacy Requests
BlueCross BlueShield of South Carolina Prior Authorization
BlueCross BlueShield of Texas Prior Authorization and Step Therapy Programs
Blue Cross of Northeastern Pennsylvania Provider Rx Prior Authorization Form
Drug Utilization Management Criteria
CareFirst BlueCross BlueShield Prior Authorization/Step Therapy
Cigna Pharmacy Forms
CVS Caremark Prior Authorization Information
Electronic Prior Authorization
Electronic Prior Authorization FAQs
Clinical Prior Authorization Criteria Request Form
Geisinger Health/Geisinger Health Plan Prior Authorization Form
Gundersen Health Plan Pharmacy Forms for Healthcare Providers: Prior Authorization
Highmark Blue Cross Blue Shield Process for Requesting Drug Coverage from a Pharmaceutical Management Program
Humana Provider Prior Authorization
Independence Blue Cross Prior Authorization: Pharmacy Benefit
Medical Mutual of Ohio Provider Area
Prior Approval List
Prior Authorization Form
Midwest Health Plan, Inc. Pharmacy Approval Criteria
Neighborhood Health Plan Standardized Prior Authorization Request Form
Regence BlueCross BlueShield RegenceRx Pharmacy page
Prior Authorization
Wellmark Blue Cross and Blue Shield Provider Drug Information
Provider Prior Authorization

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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

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.

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.

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