Download iconTREMFYA withMe Patient Brochure

A patient-friendly overview of the support offered by TREMFYA withMe.

Download iconPatient Affordability Options

Discover options that can help make TREMFYA® more affordable for your patients.

Download iconTREMFYA withMe Savings Program

The TREMFYA withMe Savings Program allows eligible commercial patients to save on their out-of-pocket medication costs.

Download iconSavings Program Rebate Form

Patients should submit this form if their pharmacy can’t process their TREMFYA withMe Savings Program card.

Download iconHealth Insurance Open Enrollment Guide

Help your patients check their health insurance options for the next plan year.

Download iconMedicare Resource Guide

Help your patients learn about the different parts of Medicare.

Download iconEnrollment and Prescription Form

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

Provider Portal

24-hour online access to benefits investigations, prior authorization support, and Savings Program enrollment and monitoring.

Download iconSample Letter of Exception

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

Download iconSample 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.

Download iconSample 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.

Download icon 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.

Download iconPatient 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.

Download iconDelay 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.

Download icon 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.