Other Practice Resources

​Other Practice Resources

Business Associate Agreement (BAA)

Use this HIPAA Business Associate Agreement to help be compliant with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).

Patient Authorization form

The Patient Authorization form will allow you to disclose your patients’ protected health information to Janssen in order for Janssen to enroll them in and contact them about TREMFYA™ support programs; provide them with educational materials, information, and services related to TREMFYA™; verify, investigate, assist with, and coordinate their coverage for TREMFYA™ with their insurers; coordinate prescription fulfillment; and assist with analyses related to the quality, efficacy, and safety of TREMFYA™, and their access to and adherence to TREMFYA™.

You will want to complete and submit a Patient Authorization form when there is not a valid Business Associate Agreement, or the Covered Entity has signed a Limitation of Services request. Remember to provide a copy of this form to your patient after they have read and signed it.

Limitation of Services request form

If you prefer that your patients not be contacted by Janssen CarePath for explanation of benefits, complete this form.

Health Plan Open Enrollment Brochure for your patients

Even if patients keep the same health plan, benefits can change. The information in the Open Enrollment brochure can help patients review their health plan coverage and make changes if needed so they can stay on treatment in the new benefit period.

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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