As you know, each health plan may have its own unique Prior Authorization (PA) form with different requirements. It’s important to gather all the necessary information during your patient’s first appointment to ensure an effective PA process with minimal delays

There are many ways to submit a PA. You can visit CoverMyMeds.com; utilize TREMFYA withMe access and affordability support via JanssenCarePathPortal.com; or contact the specialty pharmacy of your choice

Remember that, in order to submit a prior authorization via TREMFYA withMe, you have to fill out the Enrollment and Prescription Form manually or on JanssenCarePathPortal.com.

Business Associate Agreement

Complete this BAA one time only to allow you to request verification of your patients’ insurance benefits without requiring the Patient Authorization form to be signed by the patient.

Patient Authorization

If no Business Associate Agreement (BAA) is on file, you must secure patient authorization for each patient. Use this form or have your patient complete the Patient Authorization section on the Enrollment and Prescription Form. TREMFYA withMe cannot accept any patient information without an executed BAA or patient authorization on file.

Prior Authorization Checklist

Reminders and tips when completing a prior authorization for your patients.

Specialty Pharmacy Reference List

List of specialty pharmacies providing enhanced services for the TREMFYA withMe program.

Enroll eligible patients in TREMFYA withMe. From there, a TREMFYA withMe Guide will provide dedicated support to help make it easier for the patient as they begin and continue their TREMFYA^® treatment journey

Enrollment and Prescription Form

Submit the Enrollment and Prescription Form (with the Patient Authorization form signed by the patient) to enroll the patient in TREMFYA withMe.

National Access Flash Card

This resource provides an overview of the commercial coverage of TREMFYA^® and patient support offerings from TREMFYA withMe.

If a prior authorization is approved, the process is complete for the healthcare provider. Additional steps may be required if the patient’s insurance mandates a specialty pharmacy or if there are delays or any denial issues

If coverage is denied or delayed, don’t worry—your eligible, commercially insured patients can still get access to their treatment. When commercial insurance coverage is delayed >5 business days or denied, TREMFYA withMe offers eligible patients TREMFYA^® at no cost until their commercial insurance covers the medication. See program requirements at TREMFYAwithMeDelay.com.

Sample Letter of Exception

To document the request for a payer to cover a nonformulary product or when step therapy through other treatments is required.

Sample Letter of Medical Necessity

To document rationale as to why a payer’s formulary products may not be clinically appropriate for a patient. May also be used when a payer does not have a known coverage policy in effect.

Sample Letter of Appeal

To document and request a payer review of a denied coverage determination for TREMFYA^®, such as prior authorization or exception request denials.

TREMFYA withMe Delay and Denial Support

TREMFYA withMe Delay and Denial Support offers eligible patients TREMFYA^® at no cost until their commercial insurance covers the medication. See program requirements.

It’s time to get assigned to a specialty pharmacy, where your patients will receive fulfillment help in getting TREMFYA^®, and education from their TREMFYA withMe Guide about cost support options to make it more affordable

If a mandated specialty pharmacy is required by a patient’s insurance plan, then a transfer of the prescription will be needed

Access & Affordability Resources

Tools and resources that help navigate payer processes and support getting your patients started on TREMFYA^®.