Janssen Link connects your commercially insured patients to their prescribed treatment when commercial insurance is delayed > 5 days or denied. Eligible patients will receive:
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TREMFYA™ at no cost
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Ongoing support until your patients receive coverage or through the rest of the current program year* if an approval decision has not been made†
Patients are eligible for Janssen Link if:
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They have been prescribed TREMFYA™ for an FDA-approved indication
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The prescribing physician submits a Prescription Enrollment Form (PEF) to Janssen CarePath
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The prescribing physician completes and submits a form of coverage determination (ie, prior authorization, letter of medical necessity) to the commercial insurance
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Commercial insurance has been delayed > 5 business days, or denied the treatment prescribed
Ineligible denial reasons:
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Missing information on coverage determination form
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Use for a non-FDA-approved indication
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Invalid clinical rationale
This program is not available to individuals who use any state or federal government-subsidized healthcare program to cover a portion of medication costs, such as Medicare, Medicaid, TRICARE, Department of Defense, or Veterans Administration or any other federal or state healthcare plan, including pharmaceutical assistance programs.
*Program year runs March 1-February 28.
†After enrollment, Janssen CarePath conducts quarterly re-verification for TREMFYA™ patients but only contacts you and your patients if insurance coverage changes. The annual re-verification is different from the quarterly re-verification that happens upon enrollment. You and/or your patient(s) may be required to confirm/update insurance information. This annual re-verification is comprehensive and requires patient and HCP to confirm insurance status and requires the HCP to submit a new prior authorization form and other documentation. Patients who begin participation in the program during the months of November or December will be approved through the folowing calendar year and will not go through the re-verification process.
Getting started with Janssen Link:
Janssen CarePath Support:
We support your patients:
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Complete a benefits investigation
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Confirm benefits and prior authorization (PA) requirements
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Provide PA form assistance and status monitoring, as well as help with the exceptions and appeals processes
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Call your eligible patients to enroll them in Janssen Link
We coordinate medication delivery:
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Coordinate shipment of TREMFYA™ to eligible patients at no cost through the rest of the current program year if an approval decision has not been made after 90 days (if the payer approves the appeal within 90 days, patient will be transitioned to commercial product)
How it works
FAQs
If insurance coverage is denied, Janssen Biotech, Inc., will provide TREMFYA™ at no cost through the program year. For example, if your patient enrolls in the program in May or June, he or she will be enrolled until the end of February if his or her commercial insurance continues to be denied.
Applicants in November or December who are approved will be covered through the following year if insurance coverage continues to be delayed (>5 days) or denied.
If, at the end of one year, insurance coverage has not been secured, patients can repeat the program process and re-enroll for another program year if they remain eligible and you want their treatment to continue.
Eligible patients are those who have just been prescribed TREMFYA™ and who are commercially insured and whose insurance has delayed (more than 5 days) or denied their treatment. Patients in government-funded federal healthcare programs, such as Medicare, Medicaid, TRICARE, and VA, are excluded from participating.
Coverage will still need to be pursued, even if originally denied. Janssen CarePath will be there to help your office through the exceptions and appeals processes on behalf of your patient.
No. TREMFYA™ PEFs need to be submitted through Janssen CarePath for your patient to be eligible for Janssen Link.
Yes. Your patients will simply have to sign the PEF to opt in to Janssen Biotech, Inc., support services.
If you would prefer to complete a BAA, fill out the form available here.
How long will Janssen Biotech, Inc., provide TREMFYA™ for my commercial patients enrolled in the Janssen Link program?
If insurance coverage is denied, Janssen Biotech, Inc., will provide TREMFYA™ at no cost through the program year. For example, if your patient enrolls in the program in May or June, he or she will be enrolled until the end of February if his or her commercial insurance continues to be denied.
Applicants in November or December who are approved will be covered through the following year if insurance coverage continues to be delayed (5 days or greater) or denied.
If, at the end of one year, insurance coverage has not been secured, patients can repeat the program process and re-enroll for another program year if they remain eligible and you want their treatment to continue.
Which of my patients are eligible for the Janssen Link program?
Eligible patients are those who have just been prescribed TREMFYA™ and who are commercially insured and whose insurance has delayed (>5 days) or denied their treatment. Patients in government-funded federal healthcare programs, such as Medicare, Medicaid, TRICARE, Department of Defense, and VA, are excluded from participating.
Are there other requirements for the Janssen Link program?
Coverage will still need to be pursued, even if originally denied. Janssen CarePath will be there to help your office through the exceptions and appeals processes on behalf of your patient.
Can I submit the TREMFYA™ Prescription Enrollment Forms (PEFs) through my usual Specialty Pharmacy Provider (SPP)?
No. TREMFYA™ PEFs need to be submitted through Janssen CarePath for your patient to be eligible for Janssen Link.
Can my office participate in Janssen Link without an executed Business Associate Agreement (BAA)?
Yes. Your patients will simply have to sign the PEF to opt in to Janssen Biotech, Inc., support services.
If you would prefer to complete a BAA, fill out the form available here.
*If prior authorization is denied after an appeal has been filed, eligible patients will receive TREMFYA™ at no charge until the end of the current program year. Patients who begin participation in the program during the months of November or December will be approved through the following calendar year.
You will not purchase TREMFYA™, on behalf of Janssen Link patient participants, and you may not bill commercial payers for any part of the cost of TREMFYA™.
Janssen Link will also provide TREMFYA™ for the next program year if your patients re-enroll, remain eligible and you want their treatment to continue.
Janssen CarePath cannot accept any information without an executed Business Associate Agreement or Patient Authorization, which can be found on the Prescription Enrollment Form on file. In addition, a Prescription Enrollment Form must be submitted for each patient for whom treatment with TREMFYA™ is requested. Please reference the Janssen Link Enrollment Form for full program and eligibility requirements.
Patients may choose not to participate in Janssen Link.
Janssen Biotech, Inc. reserves the right to cancel or modify Janssen Link at any time.
