Prescription Information and Enrollment Form
This form is the first step connecting your patient to all of the services Janssen CarePath has to offer.
Sample Letter of Exception
Communicates when TREMFYATM is medically appropriate and necessary and should be a covered and reimbursed service.
Sample Letter of Medical Necessity
If additional support is needed to ensure coverage of TREMFYATM.
Authorized Wholesale Distributor Flash Card
To utilize when purchasing TREMFYATM.
Business Associate Agreement
Use this HIPAA Business Associate Agreement to help be compliant with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).
Additional Forms & Documents
Janssen Link, a program offered by Janssen CarePath, ensures your eligible patients receive subcutaneous TREMFYATM if commercial insurance delays (more than 5 business days) or denies their treatment.
Janssen CarePath Savings Program for TREMFYATM
Your eligible patients will pay just $5 for each dose, with a $20,000 maximum program benefit each calendar year. The Janssen CarePath Savings Program provides financial assistance to help patients with out-of-pocket costs on their TREMFYATM medication, including: deductible, co-payment, and co-insurance costs.
Patient Affordability Options
If your patients have commercial or private health insurance and need help paying for TREMFYATM, the Janssen CarePath Savings Program may be able to help.
Janssen CarePath Internet Resources for Patients
Information patients may need to help get started and stay on track.
*Up to a maximum of $20,000 program benefit per calendar year. Not valid for patients enrolled in Medicare, Medicare Part D, Medicaid, or other federally funded programs.
†Janssen Link will also provide TREMFYATM for the next program year if your patients remain eligible and you want their treatment to continue.