Help Your Patients Start and Stay on TREMFYA®
TREMFYA® (guselkumab)
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Downloadable Forms
- Business Associate Agreement
Complete a Business Associate Agreement for your practice only once. No individual patient authorizations are required. - Delay & Denial Support Reverification Guide
Use this guide to learn how to confirm your patient's eligibility for Delay & Denial Support/Janssen Link if they have previously been eligible. - Enrollment and Prescription Form
A way to find out if TREMFYA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies.
Enrollment and Prescription Form (en español para Puerto Rico) - Enrollment and Prescription Form (en español para Puerto Rico) A way to find out if TREMFYA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies. En español.
- Enrollment and Prescription Form for EMA A way to find out if TREMFYA® is covered by the patient's insurance plan, including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies. (EMA)
- Letter of Appeal
A template to send to patients' insurance companies to help get patients on treatment. - Letter of Exception
A template that you can fill out and submit to a patient’s health insurance provider asking them to cover a medication that is not on formulary. - Letter of Medical Necessity
A template that you can fill out and submit to a patient’s health insurance provider. You may use it to explain why TREMFYA® is medically necessary for your patient. - Letter of Medical Necessity (Reverification)
A template that you can fill out and submit to a patient’s health insurance provider to explain why it is medically necessary for your patient to continue on TREMFYA®. - Patient Affordability Options Discover options that can make TREMFYA® more affordable for your patients.
Patient Affordability Options (en español) - Patient Affordability Options (en español)
Discover options that can make TREMFYA® more affordable for your patients. En español. - Patient Authorization FormIndividual patient form for offices without a Business Associate Agreement.
Patient Authorization Form (en español) - Patient Authorization Form (en español)Individual patient form for offices without a Business Associate Agreement.
- Prescribing Information & Medication Guide (en español)
Product information for TREMFYA®. En español. - Resource GuideA comprehensive summary of support tools for your office to help patients start and stay on treatment.
- Savings Program Additional Co-pay Support Form
- Savings Program Overview Eligible patients using commercial or private insurance can save on out-of-pocket costs for TREMFYA®.
Savings Program Overview (en español) - Savings Program Overview (en español)
Eligible patients using commercial or private insurance can save on out-of-pocket costs for TREMFYA®. En español. - Savings Program Rebate FormA form the patient can submit if the pharmacy isn’t able to process the Janssen CarePath Savings Program card.
Savings Program Rebate Form (en español) - Savings Program Rebate Form (en español)
A form the patient can submit if the pharmacy isn’t able to process the Janssen CarePath Savings Program card. En español. - Verification of Benefits Guide (Medical)
A guide to understanding the Verification of Benefits for your patient’s medical benefits. - Verification of Benefits Guide (Pharmacy)
A guide to understanding the Verification of Benefits for your patient’s pharmacy benefits.
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Help Your Patients Start and Stay on TREMFYA®
TREMFYA withMe for Your Patients
TREMFYA withMe provides a range of dedicated support and resources to help make it easier for patients as they begin, and continue, their TREMFYA® treatment journey, including:
- Prescription fulfillment
- Cost support
- Savings Program enrollment
- Injection support
- Treatment expectations
TREMFYA withMe can help to verify insurance coverage for your patients, provide reimbursement information, find financial assistance options for eligible patients, and provide ongoing support to help patients start and stay on TREMFYA®.
Share this brochure with your patients or sign them up here.
Janssen Patient Account
Your patients and their caregivers can create an online account at MyJanssenCarePath.com, where they can learn about their insurance coverage. They can also:
- Enroll in the TREMFYA withMe Savings Program
- Manage their Savings Program benefits
- Find support throughout their treatment journey
Pharmacies
TREMFYA® is available from a wide range of pharmacies.
Janssen Care Coordinators can also provide:
- Identification of pharmacies based on your patient’s insurance coverage
- Prescription triage to pharmacy for coordination of medication delivery to your patient's home, your office, or another convenient location
If you have any questions, please call your dedicated Care Coordinator at 844-4withMe (844-494-8463), Monday–Friday, 8:00 AM to 8:00 PM ET. Multilingual phone support is available.
Janssen Nurse Support
Even after you’ve trained your patients to give themselves an injection of TREMFYA®, they may still have questions. For patients not enrolled in TREMFYA withMe, Janssen Nurse Support* can help answer their questions about giving themselves an injection at home, preparing their injection site prior to self-injecting, and properly disposing of their used syringe.
Connect your patients with Janssen Nurse Support at 877-CarePath (877-227-3728), available Monday–Friday, 9:00 AM to 8:00 PM ET. At all other times, a nurse will typically return their call in 15 minutes.
*Janssen Nurse Support is limited to education for patients about their Janssen therapy, its administration, and/or their disease. It is intended to supplement a patient's understanding of their therapy, and is not intended to provide medical advice, replace a treatment plan from the patient's doctor or nurse, provide case management services, or serve as a reason to prescribe.
Safe Returns® Disposal
Your patients can safely and securely dispose of their used TREMFYA® prefilled syringes or One-Press injectors. Safe Returns® is a used injection device disposal service available at no cost to your patients. Your patients may call 833-WITHME1 (833-948-4631) to receive a certified Safe Returns® sustainable mail-back envelope.
Internet Resources for Your Patients
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There are many useful resources available online that may help your patients understand and manage their diseases and their treatment with TREMFYA®. You may find the websites listed here helpful as referrals in educating your patients about their condition. The links provided here are for informational purposes only. No endorsement or sponsorship is implied. |
TREMFYA® Patient Website
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This website contains additional information about treatment with TREMFYA®. |
American Academy of Dermatology
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The American Academy of Dermatology is dedicated to providing dermatologists with the information and resources they need to serve their patients. Patients can learn more about dermatologists and the conditions they treat. |
Arthritis Foundation
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The mission of the Arthritis Foundation is to improve lives through leadership in the prevention, control, and cure of arthritis and related diseases. This website includes education and online community resources for people with arthritis and their families. |
Arthritis Today
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The online home of the Arthritis Foundation’s “Arthritis Today” magazine is a great source of tips and information for people living with arthritis. |
CreakyJoints
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CreakyJoints provides treatment information, advice from professionals, and public forums for people living with arthritis to share their experiences. |
National Psoriasis Foundation
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The National Psoriasis Foundation (NPF) is a non-profit organization with a mission to drive efforts to cure psoriatic disease and improve the lives of those affected. |
Call a Janssen CarePath Care Coordinator at 844-4withMe (844-494-8463), Monday−Friday, 8:00 AM to 8:00 PM ET. Multilingual phone support available.
Sign up or log in to the Provider Portal at JanssenCarePathPortal.com where you can request and review benefits investigations, enroll eligible patients in the TREMFYA withMe Savings Program, and view their Savings Program transactions.