Janssen CarePath is your one source for access, affordability, and treatment support for your patients
Access support
to help navigate payer processes
Janssen CarePath helps verify insurance coverage for your patients taking STELARA® and provides reimbursement information.
Online benefits investigation and prior authorization support at JanssenCarePathPortal.com
Affordability support
to help your patients start and stay on the treatment you prescribe
Janssen CarePath can help you find out what affordability assistance may be available for your patients taking STELARA®.
Comprehensive Provider Portal to enroll eligible patients in the STELARA withMe Savings Program and more at JanssenCarePathPortal.com
Treatment support
to help your patients get informed and stay on STELARA® that you prescribed
Janssen CarePath provides additional support to your patients, including patient education, web-based resources, and personalized reminders.
Call a Janssen CarePath Care Coordinator at 877-CarePath (877-227-3728), Monday-Friday, 8:00 am to 8:00 pm ET.
STELARA withMe Delay and Denial Support
Program Description
STELARA withMe offers eligible patients subcutaneous STELARA®(ustekinumab) at no cost until their commercial insurance covers the medication. See program requirements below.
Program Requirements
To be eligible, patient must have:
- 1. a subcutaneous STELARA® prescription for an on-label, FDA-approved indication
- 2. commercial insurance with biologics coverage
- 3. a delay of more than 5 business days or a denial of treatment from their insurance
In addition, for patient to be eligible, Prescriber must submit:
- 4. a program enrollment form*
- 5. a coverage determination form (i.e., prior authorization or prior authorization with exception) to the commercial insurance.
If coverage is denied, Prescriber must also submit a Letter of Formulary Exception, Letter of Medical Necessity or appeal within 90 days of patient becoming eligible for patient to stay in the program.
Patient is not eligible if:
- patient uses any state or federal government funded healthcare program to cover medication costs. Examples of these programs are Medicare, Medicaid, TRICARE, Department of Defense, and Veterans Administration
- prior authorization is denied due to missing information on coverage determination form, use for a non–FDA-approved indication, or invalid clinical rationale
Patient is eligible until commercial insurance covers the medication. Program requires periodic verification of insurance coverage status to confirm continued eligibility.
Delay and Denial Support covers the cost of therapy only—not associated administration cost. Prescriber cannot bill commercial insurance plan for any part of the prescribed subcutaneous treatment. Patient cannot submit the value of the free product as a claim for payment to any health plan. Program good only in the United States and its territories. Void where prohibited, taxed, or limited by law. Program terms may change.
Participating prescribers authorize STELARA withMe to:
- 1. conduct a benefits investigation and confirm prior authorization requirements
- 2.provide prior authorization form assistance and status monitoring, including the exceptions and appeals processes
- 3. refer eligible patients to Wegmans Specialty Pharmacy for further program support and shipment of medication
- 4. support the transition of patients to commercial product if the medication is covered
- 5. check insurance coverage status during the program.
*STELARA withMe, via Janssen CarePath, cannot accept any information without an executed Janssen CarePath Business Associate Agreement and/or Patient Authorization on file. The Patient Authorization can be found on the Benefits Investigation and Prescription Form, or patient can create an account on MyJanssenCarePath.com and electronically sign a patient authorization there.
STELARA withMe Savings Program
Support for patients using commercial or private insurance to pay for medication
STELARA withMe Savings Program can help eligible patients save on their out-of-pocket medication costs for STELARA®. Your eligible patients will pay $5 per dose. Maximum program benefit per calendar year shall apply. Not valid for patients using Medicare, Medicaid, or other government funded programs to pay for their medications. Terms expire at the end of each calendar year and may change. Program does not cover the cost to give patients their treatment. See program requirements at STELARAwithMeSavings.com.
Online enrollment and tracking of patient Savings Program benefits by you, the pharmacy, or the patient
- Providers can enroll patients and view their Savings Program benefits with a Provider Portal Account at JanssenCarePathPortal.com
- Patients can enroll, manage Savings Program benefits and submit rebate requests if necessary on their Janssen CarePath Account at MyJanssenCarePath.com
STELARA withMe is limited to education for patients about STELARA®, its administration, and/or their disease, and is not intended to provide medical advice, replace a treatment plan from the patient’s doctor or nurse, or provide case management services.