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.
In-Home Pretest Program
The In-Home Pretest Program, for eligible commercially insured patients, provides in-home pretest support at no cost for pretests that may be required when starting treatment with PONVORY™. You may be eligible for the In-Home Pretest Program if you are age 18 or older with commercial or private health insurance. There is no income requirement. Terms expire at the end of each calendar year and may change. The program is not valid for residents of MA, MI, MN, or RI. Please see full program requirements here.
How the In-Home Pretest Program Works
If you are eligible, and your healthcare professional has selected in-home testing for you, Janssen CarePath will call you to schedule in-home testing for the pretests your healthcare provider has selected on the Prescription Enrollment Form. Available pretests will be completed at the patient's home by a qualified healthcare provider. All test results will be sent back to your healthcare provider for review. Your healthcare provider will need to complete an attestation to confirm you are ready to start treatment with PONVORY™.
How to Get Started with the In-Home Pretest Program
- To get started, your healthcare provider must complete the Prescription Enrollment Form, select In-Home Pretest Program, and fax to Janssen CarePath to enroll patients.
- You will need to sign the Janssen Patient Support Program Patient Authorization Form. The Patient Authorization can be found on the Prescription Enrollment Form or can be completed online at MyJanssenCarePath.com/PatientAuth.
Pretest Scheduling Support
If you chose not to have in-home testing, your Care Coordinator can still help you schedule certain tests your doctor may order before you start treatment.
If you have questions, please call a Janssen CarePath Care Coordinator at 877-CarePath (877-227-3728), Monday–Friday, 8:00 AM to 8:00 PM ET. Multilingual phone support is available.
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.
Get started with a Janssen CarePath Account
Sign Up or Log In to your personal Janssen CarePath Account, so you can learn about your insurance coverage for PONVORY™; if eligible, enroll in the Janssen CarePath Savings Program or Pretest Rebate Program and manage program benefits; and find support to help you start and stay on track with your Janssen medication.