RESOURCES
For Patient
TREMFYA withMe Patient Brochure
A patient-friendly overview of the support offered by TREMFYA withMe.
TREMFYA withMe Savings Program
The TREMFYA withMe Savings Program allows eligible commercial patients to save on their out-of-pocket medication costs.
Patients should submit this form if their pharmacy can’t process their TREMFYA withMe Savings Program card.
Discover options that can help make TREMFYA® more affordable for your patients.
Health Insurance Open Enrollment Guide
Help your patients check their health insurance options for the next plan year.
Help your patients learn about the different parts of Medicare.
TREMFYA withMe Patient Brochure
A patient-friendly overview of the support offered by TREMFYA withMe.
Discover options that can help make TREMFYA® more affordable for your patients.
TREMFYA withMe Savings Program
The TREMFYA withMe Savings Program allows eligible commercial patients to save on their out-of-pocket medication costs.
Patients should submit this form if their pharmacy can’t process their TREMFYA withMe Savings Program card.
Health Insurance Open Enrollment Guide
Help your patients check their health insurance options for the next plan year.
Help your patients learn about the different parts of Medicare.
Enrollment and Prescription Form
This form is the first step to understanding your patient’s insurance coverage and enrolling the patient in other resources.
24-hour online access to benefits investigations, prior authorization support, and Savings Program enrollment and monitoring.
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.
To document and request a Payer review of a denied coverage determination for TREMFYA®, such as prior authorization or exception request denials.
Complete this Business Associate Agreement (BAA) one time only to allow you to request verification of patients’ insurance benefits without requiring individual Patient Authorization.
Some elements of the program may require a Patient Authorization Form. Use this form or have patient complete the authorization on the Enrollment and Prescription Form.
Delay and Denial Support Reverification Guide
Use this guide to learn how to confirm your patient's eligibility for Delay and Denial Support if they have previously been eligible.
Specialty Pharmacy Reference List
Network of specialty pharmacies providing enhanced services for patients enrolled in TREMFYA withMe.
Access & Affordability Resources
Tools and resources that help navigate payer processes and support getting your patients started on TREMFYA®.
For Your Office
Enrollment and Prescription Form
This form is the first step to understanding your patient’s insurance coverage and enrolling the patient in other resources.
24-hour online access to benefits investigations, prior authorization support, and Savings Program enrollment and monitoring.
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.
To document and request a Payer review of a denied coverage determination for TREMFYA®, such as prior authorization or exception request denials.
Complete this Business Associate Agreement (BAA) one time only to allow you to request verification of patients’ insurance benefits without requiring individual Patient Authorization.
Some elements of the program may require a Patient Authorization Form. Use this form or have patient complete the authorization on the Enrollment and Prescription Form.
Delay and Denial Support Reverification Guide
Use this guide to learn how to confirm your patient's eligibility for Delay and Denial Support if they have previously been eligible.
Specialty Pharmacy Reference List
Network of specialty pharmacies providing enhanced services for patients enrolled in TREMFYA withMe.
Access & Affordability Resources
Tools and resources that help navigate payer processes and support getting your patients started on TREMFYA®.
Once you sign up your patients, they’ll have additional support on their treatment journey.
