Your Janssen CarePath Care Coordinator can:
- Review your health plan benefits to help answer questions you may have about insurance coverage for SIMPONI®
- Identify options that may help make SIMPONI® more affordable, if needed
- Work with your pharmacy to process and deliver your SIMPONI® medication to your home or your doctor’s office
- Provide treatment education support. We also invite you to learn more at Simponi.com
If you have questions, please call Janssen CarePath at 877-CarePath (877-227-3728), Monday - Friday, 8:00 AM to 8:00 PM ET.
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 SIMPONI®; if eligible, enroll in the Janssen CarePath Savings Program and manage program benefits; and sign up for treatment support that may help you start and stay on track with your Janssen medication.
If your health plan does not approve SIMPONI® 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 enables eligible patients to receive SIMPONI® at no cost until you receive coverage or until the end of the current program year if the following program requirements are met.
- You have been prescribed SIMPONI® for an on-label, FDA-approved indication
- 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 a portion of medication costs, such as Medicare, Medicaid, TRICARE, Department of Defense, or Veterans Administration
- You cannot submit the value of the free product as a claim for payment to any third-party payer
- You are not eligible if the prior authorization is denied due to missing information on coverage determination form, use for a non-FDA-approved indication, or invalid clinical rationale
- You must contact Janssen CarePath if you switch from commercial health insurance coverage to a government-funded healthcare program at any point during the program year
- Your prescriber must enroll you in Jassen Link, which may require you to sign a Patient Authorization Form. The Patient Authorization can be found on the enrollment form your prescriber completes, or you can create an account on MyJanssenCarePath.com and electronically sign a Patient Authorization there.
- Your prescriber agrees to not purchase the Janssen medication on your behalf, and not bill commercial payers for any part of the prescribed subcutaneous treatment
- Your prescriber completes and submits a form of coverage determination (ie, prior authorization or prior authorization with exception) to the commercial insurance
- If coverage is denied, your prescriber challenges the coverage denial with an exception, Letter of Medical Necessity, or appeal within 90 days
- Program covers the cost of therapy only—not associated administration cost
- No portion of the value of the free product will count towards the patient’s applicable out-of-pocket cost-sharing obligations
- Program year runs March 1 - February 28
- Janssen CarePath reserves the right to cancel or modify Janssen Link at any time
A nurse is just a phone call away
Even after you’ve been trained by a healthcare professional to give yourself an injection, you may still have questions. Janssen Nurse Support* can help answer questions about giving yourself an injection at home with the SmartJect® autoinjector or prefilled syringe, preparing your injection site prior to self-injecting, and properly disposing of your used SmartJect® autoinjector or used syringe.
Connect 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 your call in 15 minutes.
*Janssen Nurse Support is limited to education about your Janssen medication, its administration, and/or the condition it treats. It is not intended to provide medical advice, replace a treatment plan you receive from your doctor or nurse, or serve as a reason for you to start or stay on treatment.
Step-by-step injection demonstration videos
At Janssen CarePath, we've created tools to help you when self-injecting SIMPONI®, including these demonstration videos:
- For these approved indications: moderate to severe rheumatoid arthritis, active psoriatic arthritis, or active ankylosing spondylitis, click here
- For the approved indication of moderate to severe ulcerative colitis, click here
Additionally, we've created the SmartJect® autoinjector reusable trainer. With no needle or medicine inside, the SmartJect® autoinjector reusable trainer may be a helpful way to practice giving yourself an injection as often as you like. Visit Simponi.com to order a reusable trainer and/or a treatment preparation mat that is printed with step-by-step instructions for using your autoinjector.
Health Insurance Open Enrollment Guide
Even if you keep the same health plan year to year, your benefits can change. This guide can help you review your coverage and make changes if needed during the open enrollment period so you can stay on treatment in the new benefit period, usually beginning January 1.
If you’re enrolled in Medicare and using Medicare insurance to pay for your medications, our Medicare Resource Guide provides important information to consider as you are selecting your insurance coverage.