Your Janssen CarePath Care Coordinator can:
- Review your health plan benefits to help answer questions you may have about insurance coverage for PONVORY™
- Identify options that may help make PONVORY™ more affordable, if needed
- Provide more information about a trial program that helps patients start on PONVORY™. At the conclusion of the trial program, you and your healthcare provider decide whether to continue treatment
- Connect you with the Wellness Companion Program* by Janssen CarePath (see below)
The Wellness Companion Program* by Janssen CarePath
Here for your MS journey.
The Wellness Companion Program* by Janssen CarePath provides one-on-one education to help you get started and continue treatment with PONVORY™. Your Wellness Companion can connect you to resources to help you partner with your healthcare professional during your treatment journey with relapsing multiple sclerosis (MS).
Look to the Wellness Companion Program for:
- Engagement: A dedicated companion for your relapsing MS journey with PONVORY™, available to you via phone and email.
- Education: Resources to help you learn more about PONVORY™ and living with relapsing MS.
- Empowerment: An educational support program built around your needs, your daily life, and your schedule.
Find out more!
Talk with your doctor about PONVORY™. If you and your doctor have decided that PONVORY™ is right for you, ask your healthcare professional about enrolling into the Wellness Companion program.
*The Wellness Companion Program is limited to education about PONVORY™, its administration, and/or relapsing MS. It is intended to supplement your understanding of your prescribed therapy. It does not provide medical advice, health coaching or improved wellness as a result of engaging with the program, replace a treatment plan from your healthcare professional, or serve as a reason for you to start or stay on treatment. Only your healthcare professional can provide medical advice and design your treatment plan.
Pretest Scheduling Support
Your Care Coordinator can help you schedule certain tests your doctor may order before you start treatment. Please call Janssen CarePath at 877-CarePath (877-227-3728), Monday–Friday, 8:00 AM to 8:00 PM ET.
If your health plan does not approve PONVORY™ 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 Link for PONVORY™
Supports eligible, commercially insured patients until they receive coverage for their prescribed treatment.
Janssen Link for PONVORY™ lets eligible patients get PONVORY™ (ponesimod) at no cost until you receive coverage or for up to 24 months from program enrollment, whichever comes first, if these requirements are met.
- You have been prescribed PONVORY™ for an on-label, FDA-approved use
- You have commercial insurance that has delayed (>5 business days) or denied your treatment
- You do not use any state or federal government-funded healthcare program to cover medication costs. Examples of these programs are Medicare, Medicaid, TRICARE, Department of Defense, and Veterans Administration
- You will need to sign a Patient Authorization Form
- You cannot submit the value of the free product as a claim for payment to any health plan
- You do not qualify if prior authorization is denied due to missing information, non-FDA-approved use, or invalid clinical rationale
- You must contact the program if you switch from commercial health insurance to a government-funded healthcare program
- Your prescriber must submit an enrollment form for Janssen Link for PONVORY™
- Your prescriber completes and submits a form of coverage determination (i.e., prior authorization or prior authorization with an exception) to the commercial insurance
- If coverage is denied, your prescriber must challenge the denial with an exception, Letter of Medical Necessity, or appeal within 90 days
- Patients are eligible until they receive coverage or for up to 24 months of coverage from program enrollment, whichever comes first.
- Program covers the cost of therapy only—not any associated assessments including pre-clinical tests, first dose observations, or administration costs
- The value of the free product will not count towards your out-of-pocket cost-sharing obligations
- Program good only in the United States and its territories. Void where prohibited, taxed, or limited by law.
- Program terms may change.