Publish Date: 
Wed, 11/18/2020 - 07:11

Janssen CarePath can:

  • Review your health plan benefits to help answer questions you may have about insurance coverage for OPSUMIT®
  • Identify options that may help make OPSUMIT® more affordable, if needed
  • Connect you with a dedicated PAH Companion* for one-on-one educational conversations and support
  • Identify and coordinate with a specialty pharmacy to arrange shipment of your Janssen medication

*The PAH Companion Program is limited to education about your Janssen therapy, its administration, and/or PAH. It is intended to supplement your understanding of your therapy, and does not provide medical advice or replace a treatment plan from your doctor, nurse, or healthcare team.

OPSUMIT® Voucher Program

A free 30-day trial offer is available for eligible patients to help you become familiar with OPSUMIT®.

At the conclusion of the program, you and your healthcare provider decide if it is appropriate to continue treatment. Subject to 1 (one) use per lifetime for the first 30-day supply of OPSUMIT®. Terms expire at the end of each calendar year and may change. This Voucher Program is open to patients who have commercial insurance, government coverage, or no insurance coverage; however, there is no guarantee of continuous accessibility after the program ends. Ask your doctor about the OPSUMIT® Voucher Program.

See full program requirements

Getting Started with OPSUMIT®

OPSUMIT® is delivered by a specialty pharmacy—it's not something that's kept in stock at your local retail pharmacy. The following is a typical process when starting out with OPSUMIT®, though your experience may vary.

        • Prescription Prescription

          Your doctor selects OPSUMIT® as your new treatment.

          • Your healthcare team completes all the forms necessary to start you on the Janssen medicine. For OPSUMIT®, these forms include your prescription and, for females, enrollment in a program to make sure you use effective birth control during OPSUMIT® treatment and for 1 month after treatment discontinuation

          OPSUMIT® REMS Program enrollment

          OPSUMIT® can cause serious birth defects if taken during pregnancy. If you are female, you must enroll in the OPSUMIT® Risk Evaluation and Mitigation Strategy (REMS) Program.

          The OPSUMIT® REMS Program requires that, if you are able to get pregnant, you use 2 acceptable forms of birth control during treatment with OPSUMIT® and for 1 month after stopping OPSUMIT®, because the medicine may still be in your body. It also includes a monthly pregnancy test.

          If you are female, your healthcare team will enroll you in the OPSUMIT® REMS Program at the start of your treatment.

        • Insurance Verification Insurance verification

          The insurance company may ask your healthcare provider for additional information before they pay for your medicine.

          • A Janssen CarePath Care Coordinator can help with this process by gathering additional information from your healthcare team
        • Delivery of Medicine Delivery of medicine

          OPSUMIT® is shipped to you by a specialty pharmacy.

          • A Janssen CarePath Coordinator will help you connect with a specialty pharmacy that delivers OPSUMIT® in your area
          • Each month, the specialty pharmacy will call you to confirm details of the delivery, make sure you've completed a pregnancy test if required, and arrange your refill
          • The shipment is usually quick, but the process leading up to your first delivery could take more than 2 weeks
          • Before shipping, the specialty pharmacy will call you to confirm some details, including the shipment date and verification that you've completed a pregnancy test (if required). Be sure to answer, or call the specialty pharmacy back if they leave a message

          Remember, the call from your specialty pharmacy may come from a phone number that you don't know. If you miss the call, it's important that you call back.

        • Refills Refills

          Females who are able to get pregnant will need to complete required monthly testing and your doctor must verify your prescription. Once this is completed, the specialty pharmacy will ship your refill.

Your Janssen CarePath Care Coordinator may need additional information from you at the start of treatment

When you speak with a Care Coordinator, they may ask for additional information, including:

  • Details of your healthcare plan, including the name and contact information for the insurance company and your policy number
  • The name and contact information of your prescribing doctor (including the fax number)
  • Further details from your healthcare team, if your initial claim is denied

If you change insurance plans or healthcare providers, speak with your healthcare team and a Care Coordinator in a timely manner to make sure you can continue your treatment.

Contact a Care Coordinator with questions at , Monday–Friday, 8:00 AM to 8:00 PM ET.

If your health plan does not approve OPSUMIT® treatment

Sometimes you may not be able to obtain the medication that your doctor has ordered for you. For example, your health plan might not cover the medication because it is not on the plan’s drug list (formulary) or the cost is higher than you think you should have to pay. In these situations, you and your doctor have the right to ask the health plan to explain its decision and to consider making the medication available to you as an exception to its policies.

Janssen PAH Link for OPSUMIT®

The Janssen PAH Link program enables eligible commercially insured patients to receive OPSUMIT® (macitentan) at no cost until you receive coverage or through the rest of the calendar year if an approval decision has not been made in 90 days.

See full eligibility requirements

This program is not available to individuals who use any state or federal government-funded healthcare program to cover a portion of medication costs, such as Medicare, Medicaid, TRICARE, Department of Defense, or Veterans Administration. Program is for medication only. Terms expire at the end of each program year and may change.