TREMFYA®

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XARELTO®

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INVEGA SUSTENNA®

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UPTRAVI®

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<div className="custom-foot xarelto-jcp-resources d-none"><p className="text-one"><strong>XARELTO® is licensed from Bayer HealthCare AG, 51368 Leverkusen, Germany.</strong></p><p className="text-second">© Johnson &amp; Johnson Health Care Systems Inc. 2024 <span className="ex-sp ps-2">12/24</span> <span className="ex-sp ps-2">cp-412172v3</span></p><div className="image-jnj"><div className="media media--type-image media--view-mode-media-library media--view-mode-default">                    <img src="/system/files/2024-12-27/04-33-26/JNJ_Logo_SingleLine_Red_RGB.svg" alt="Johnson &amp; Johnson Red Icon" className="img-fluid">        </div></div></div><footer className="text-white footer" id="global-footer"><div className="wrapper"><div className="region region-footer mx-0"><div className="block block-panels-mini clearfix px-0"><div className="row bs-row top-row region-row"><div className="col bs-col col-sm-12 region-col"><div className="footer-disclaimer"><div className="panel-content"><div className="field-type-text-with-summary"><div className="field-items"><div className="field-item even"><p className="general-only">Information about your patient’s insurance coverage, cost support options, and treatment support is given by service providers for <span className="text-nowrap">J&amp;J withMe</span>. The information you get does not require you or your patient to use any <span className="text-nowrap">J&amp;J</span> product. Because the information we give you comes from outside sources, <span className="text-nowrap">J&amp;J withMe</span> cannot promise the information will be complete.</p><p className="stelara-only">Information about your patient’s insurance coverage, cost support options, and treatment support is given by service providers for <span className="text-nowrap">STELARA withMe</span> cost support. The information you get does not require you or your patient to use any <span className="text-nowrap">J&amp;J</span> product. Because the information we give you comes from outside sources, <span className="text-nowrap">STELARA withMe</span> cannot promise the information will be complete.</p><p className="tremfya-only">Information about your patient’s insurance coverage, cost support options, and treatment support is given by service providers for <span className="text-nowrap">TREMFYA withMe</span>. The information you get does not require you or your patient to use any <span className="text-nowrap">J&amp;J</span> product. Because the information we give you comes from outside sources, <span className="text-nowrap">TREMFYA withMe</span> cannot promise the information will be complete.</p></div></div></div></div></div></div></div><div className="row bs-row main-row region-row"><div className="left-col col-12 bs-col col-sm-4 col-lg-4 px-0"><div className="footer-logo"><div className="pane-content"><div className="field-type-text-with-summary"><div className="field-item even"><div className="media media-element-container media-default"><div className="file file-image"><div className="content non-withme-footer-logo"><a href="https://www.jnjwithme.com/"><div className="media media--type-image media--view-mode-media-library media--view-mode-default">                    <img src="/system/files/2023-10-16/19-08-12/logo-footer-2.svg" alt="Home" loading="lazy" className="img-fluid">        </div></a></div><div className="content withme-footer-logo"><a href="https://www.jnjwithme.com/"><div className="media 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INVOKAMET® XR

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TALVEY® (talquetamab-tgvs)

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TALVEY®

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RYBREVANT®

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<div className="banner-notice"><rce-container className="container bs-container"><rce-row className="row bs-row"><rce-col className="col bs-col"><div className="withme-banner" id="withmeBanner"><p><span className="no-break"><strong>Janssen CarePath</strong></span><strong> is becoming J&amp;J withMe. </strong>Our name may be changing, but our commitment to patients stays the same. <button className="learnmore" type="button" data-bs-toggle="modal" data-bs-target="#withmemodal">                                                                                  Learn More                                                                                </button> <button className="close-banner">X</button></p></div></rce-col></rce-row></rce-container></div><div className="modal fade" id="withmemodal" tabindex="-1" aria-labelledby="withmeModalLabel" aria-hidden="true"><div className="modal-dialog"><div className="modal-content"><p><button className="btn-close" type="button" data-bs-dismiss="modal" aria-label="Close">X</button></p><div className="modal-body"><div className="popup-logo"><div className="media media--type-image media--view-mode-media-library media--view-mode-default">                    <img src="/system/files/styles/large/private/2024-07-11/16-54-37/jnj-withme-logo.png?itok=IMrN78Gl" width="480" height="214" alt="J&amp;J withMe Logo" title="J&amp;J withMe Logo" loading="lazy" className="img-fluid image-style-large">        </div></div><p className="withme-popup-h">Janssen CarePath is becoming J&amp;J withMe. During this transition, you may see both program names in use.</p><p><strong>At Johnson &amp; Johnson, we are committed to helping people live fuller lives.</strong> Our J&amp;J withMe program is here at every step to provide personalized support to help patients start and stay on their J&amp;J medicines.</p></div></div></div></div><div className="modal fade" id="withmemodalonco" tabindex="-1" aria-labelledby="withmeModalLabelonco" aria-hidden="true"><div className="modal-dialog"><div className="modal-content"><p><button className="btn-close" type="button" data-bs-dismiss="modal" aria-label="Close">X</button></p><div className="modal-body"><div className="popup-logo"><div className="media media--type-image media--view-mode-media-library media--view-mode-default">                    <img src="/system/files/styles/large/private/2024-07-11/16-54-37/jnj-withme-logo.png?itok=IMrN78Gl" width="480" height="214" alt="J&amp;J withMe Logo" title="J&amp;J withMe Logo" loading="lazy" className="img-fluid image-style-large">        </div></div><p className="withme-popup-h">Janssen CarePath is becoming J&amp;J withMe. During this transition, you may see both program names in use.</p><p><strong>At Johnson &amp; Johnson, we are committed to helping people live fuller lives.</strong> Our J&amp;J withMe program is here at every step to provide personalized support to help patients start and stay on their J&amp;J medicines.</p></div></div></div></div>

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<rce-modal className="modal bs-modal jcp-common-video-popup" id="my-experience-brightcove" show={showBCPopup} onHide={onBCPopupHidden}><rce-modal-header className="modal-header bs-modal-header" closeButton={true}></rce-modal-header><rce-modal-body className="modal-body bs-modal-body"><rce-brightcove-video className="brightcove-player react-brightcove-player" accountId="4317630935001" videoId="6314734494112"></rce-brightcove-video><div className="portal-links d-flex py-3"><a className="portal-signup text-center" href="https://www.janssencarepathportal.com/s/login/SelfRegister" target="_blank">Sign up for Provider Portal</a><a className="portal-login text-center" href="https://www.janssencarepathportal.com/s/login/" target="_blank">Log In</a></div></rce-modal-body></rce-modal>

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<p className="blue-text">Treatment and Cost Support Are Now Provided by <em>SPRAVATO withMe</em></p><div className="media-embed spravatowithmelogo-wrapper"><div className="media media-element-container media-default img-spravato-withme"><div className="file file-image file-image-svgxml" id="file-374"><div className="content"><div className="media media--type-image media--view-mode-media-library media--view-mode-default">                    <img src="/system/files/2024-03-29/12-29-15/spr_wme_rgb_fc_pos.svg" alt loading="lazy" className="img-fluid">        </div></div></div></div><div className="media media-element-container media-default img-spravato"><div className="file file-image file-image-svgxml" id="file-375"><div className="content"><div className="media media--type-image media--view-mode-media-library media--view-mode-default">                    <img src="/system/files/2024-03-29/12-31-07/spravato_logo_28mg.svg" alt="SPRAVATO®" title="SPRAVATO®" loading="lazy" className="img-fluid">        </div></div></div></div></div><p className="sparvato-anchor"><a href="https://www.spravatohcp.com/spravato-with-me" id="redirect-spravato" target="_BLANK"><strong>Click here</strong></a> to learn more about <em>SPRAVATO withMe</em>.</p>

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<div className="delay-denial"><div className="insurance-coverage"><div className="product-section"><section className="product-white-area product-welcome-banner menu-padding"><section className="product-welcome"><h1 className="product-header">TREMFYA withMe Delay and Denial Support for PsO/PsA</h1><nav aria-label="breadcrumb"><ol className="breadcrumb"><li className="breadcrumb-item"><a href="/">Home</a></li><li className="breadcrumb-item" aria-current="page"><a href="/hcp/tremfya">TREMFYA®</a></li><li className="breadcrumb-item" aria-current="page"><a href="//tremfya/insurance-coverage/delay-and-denial-support">Insurance Coverage</a></li></ol></nav></section><section className="banner-text box-mobile d-none d-md-block"><div className="row"><div className="container bs-container"><div className="row"><div className="col col-md-12 product-teaser"><p><span className="text-nowrap">TREMFYA withMe</span> offers eligible patients TREMFYA® <strong>at no cost</strong> until their commercial insurance covers the medication. See program requirements below.</p></div></div></div></div></section></section><section className="banner-text box-mobile d-block d-md-none"><div className="row"><div className="container bs-container"><div className="row"><div className="col col-md-12 product-teaser"><p><span className="text-nowrap">TREMFYA withMe</span> offers eligible patients TREMFYA® <strong>at no cost</strong> until their commercial insurance covers the medication. See program requirements below.</p></div></div></div></div></section><div className="row coding-row simponi-style1"><div className="col col-md-4"><span className="bluetext">Need Delay and Denial Support?</span></div><div className="col col-md-8 coverage"><ul className="tick-list"><li>Complete a benefits investigation request in the Provider Portal at <a className="icon-bold" href="https://Portal.JNJwithMe.com" target="_blank">Portal.JNJwithMe.com</a><br>OR</li><li>Download the <a className="translated-header-link pdf" href="/system/files/2025-05-08/15-16-21/TREMFYA_withMe_Enrollment_and_Prescription_Form_Digital.pdf" data-entity-type="media" data-entity-uuid="5fcc66e7-df4c-4670-90d3-7bff73a85887" data-entity-substitution="media" target="_blank" title="Patient Enrollment Form">Patient Enrollment Form</a>, complete the form, and fax to <span className="text-nowrap">TREMFYA withMe</span> at 844-322-9402.</li></ul></div></div><div className="row coding-row"><div className="col col-md-4"><span className="bluetext">Program Requirements</span></div><div className="col col-md-8 coverage"><p className="para-bold">To be eligible, patient must have:</p><ul className="patient-coverage"><li><em>1</em> A TREMFYA® prescription for an on-label, FDA-approved indication</li><li><em>2</em> Commercial insurance with biologics coverage</li><li><em>3</em> A delay of more than 5 business days or a denial of treatment from their insurance</li></ul><p>In addition, for patient to be eligible, Prescriber must submit:</p><ul className="patient-coverage"><li><em>4</em> A Patient Enrollment Form</li><li><em>5</em> A coverage determination form (eg, prior authorization or prior authorization with exception) to the commercial insurance</li></ul><p>If coverage is denied, Prescriber must also submit a Letter of Formulary Exception, Letter of Medical Necessity or appeal within 90 days of patient becoming eligible for patient to stay in the program.</p><p className="para-bold">Patient is not eligible if:</p><ul className="patient-coverage"><li><em>1</em> Patient uses any state- or federal government-funded healthcare program to cover medication costs</li><li className="patient-coverage-example">Examples of these programs are Medicare, Medicaid, TRICARE, Department of Defense, and Veterans Administration</li><li><em>2</em> Prior authorization is denied due to missing information on coverage determination form, used for a non-FDA-approved indication, or invalid clinical rationale</li></ul><p>Patient is eligible until commercial insurance covers the medication. Program requires periodic verification of insurance coverage status to confirm continued eligibility.</p><p>Delay and Denial Support covers the cost of therapy only—not associated administration cost. Prescriber cannot bill commercial insurance plan for any part of the prescribed subcutaneous treatment. Patient cannot submit the value of the free product as a claim for payment to any health plan. Program good only in the United States and its territories. Void where prohibited, taxed, or limited by law. Program terms may change.</p><p className="para-bold">Participating prescribers authorize <span className="text-nowrap">TREMFYA withMe</span> to:</p><ul className="patient-eligible"><li><em>1</em> conduct a benefits investigation and confirm prior authorization requirements</li><li><em>2</em> provide prior authorization form assistance and status monitoring, including the exceptions and appeals processes</li><li><em>3</em> refer eligible patients to the specialty pharmacy for further program support and shipment of medication</li><li><em>4</em> support the transition of patients to commercial product if the medication is covered</li><li><em>5</em> check insurance coverage status during the program</li></ul><p>The patient support and resources provided by <span className="text-nowrap">TREMFYA withMe</span> are not intended to give medical advice, replace a treatment plan from the patient’s healthcare provider, offer services that would normally be performed by the provider’s office, or serve as a reason to prescribe TREMFYA®.</p></div></div></div></div></div>

Tremfya - TREMFYA withMe Delay and Denial Support for PsO/PsA