Medicaid
- Janssen CarePath Oral PAH Savings ProgramEligible patients using commercial or private insurance can save on out-of-pocket-costs for UPTRAVI®.
- Janssen CarePath Resource GuideA comprehensive summary of support tools for your office to help patients start and stay on treatment.
- Patient Affordability OptionsDiscover options that can make UPTRAVI® more affordable for your patients.
- Patient Authorization FormA form for patients to allow their providers, insurers, and Janssen to share health information about them.
Patient Authorization Form (en español) - Patient Authorization Form (en español)A form for patients to allow their providers, insurers, and Janssen to share health information about them.
- Prior Authorization TipsA list of items and information that may be needed to obtain a coverage decision from an insurer.
- Sample Letter of AppealA template to send to patients' insurance companies to help get patients on treatment.
- Sample Statement of Medical NecessityA template that you can fill out and submit to a patient’s health insurance provider. You may use it to explain why UPTRAVI® is medically necessary for your patient.
- Steps to Getting Your MedicineA patient-friendly guide to the verification and delivery process.
Steps to Getting Your Medicine (en español) - Steps to Getting Your Medicine (en español)A patient-friendly guide to the verification and delivery process.
- UPTRAVI® Dose Adjustment Phase GuideA patient guide that highlights the important steps and information about titration with UPTRAVI®.
- UPTRAVI® Prescription and Statement of Medical Necessity (PSMN)Complete and submit this form first to get your patient started on UPTRAVI®.
- UPTRAVI® Prescription and Statement of Medical Necessity (PSMN)—For Veterans Affairs Patients OnlyComplete and submit this form first to get your Veterans Affairs patient started on UPTRAVI®.

Medicaid
Medicaid provides free or low-cost health coverage to Americans with limited income and resources. Low-income adults, children, pregnant women, elderly adults, and people with disabilities may be eligible. Medicaid is run by each state. The program is funded jointly by the states and the federal government. Coverage for UPTRAVI® may depend on the indication, along with other factors. Since information varies by state, we recommend contacting the state directly or reviewing its website.
Janssen CarePath can help Medicaid patients with Benefits Investigations and Prior Authorization support.
Visit your state’s Medicaid page for more coverage information. You can use the menu below to find contact details for your state.