Patient assistance
May provide TREMFYA at no cost for up to one year to eligible patients with inadequate coverage who meet current income and program criteria.
What it does
The patient and prescriber use the TREMFYA withMe form to request assistance and submit household, coverage, prescription, and authorization information for program review.
Open official program pagePotentially available to eligible US patients with no or inadequate coverage who meet household-income, prescription, residence, and outpatient-prescriber criteria.
Complete the relevant patient and assistance sections of the current form.
Provide household-income and insurance evidence requested by the program.
Call for screening or use the current enrollment form. Patient and prescriber complete their sections and submit income, coverage, authorization, and prescription records.
Best for: Services requiring clinical information, a prescription, or prescriber attestation
Patient completes demographics and the authorization/consent section of the official form.
Owner: Patient
Have ready: Contact information, Signature and date
Patient, Prescriber And Clinic Staff, Johnson & Johnson Patient Assistance Program
TREMFYA withMe
Savings, access, Nurse Guide, injection, and patient-support services.
Monday-Friday, 8 AM-11 PM ET
Official enrollment form covers access, temporary product, nursing, and assistance selections.
Complete the prescriber section and valid TREMFYA prescription.
Prescriber completes the prescription, clinical, insurance, and service-selection sections and attaches supporting records.
Owner: Prescriber or clinic staff
Have ready: Patient authorization, Income evidence, Insurance or denial evidence, Provider certification, Prescription
Submit the completed form by fax to 1-844-322-9402.
Owner: Clinic staff
Best for: Patients who may lack adequate coverage
Provide the requested prescription, insurance, contact, and consent information.
Owner: Patient or caregiver
Have ready: Prescription details, Insurance card, Prescriber contact information
After enrollment: The program communicates eligibility and fulfillment. Approved assistance is time-limited.
If there is a problem: Call to identify a missing patient signature, provider section, income record, coverage record, or prescription.
