TREMFYA^® RESOURCES

Choose TREMFYA®, Get TREMFYA® Brochure

An overview of coverage and support programs to help your patients start and stay on TREMFYA®.

Prescription Information and Enrollment Form

This form is the first step to understanding your patient's insurance coverage and enrolling the patient in other resources.

TREMFYA® Prior Authorization Checklist

Reminders and tips when completing prior authorizations for your patients.

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.

TREMFYA withMe Delay and Denial Support

A resource that provides a detailed guide on how to get support in the event of a coverage delay or denial for your commercially insured patients.

Sample Letter of Appeal

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

Business Associate Agreement

Complete this Business Associate Agreement (BAA) one time only to allow you to request verification of patients’ insurance benefits without requiring individual Patient Authorization.

Patient Authorization

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

TREMFYA withMe Specialty Pharmacy List

Quick reference guide to Specialty Pharmacy partners within the TREMFYA withMe program.