Temporary access
May provide subcutaneous TREMFYA at no cost to eligible commercially insured patients while coverage is delayed or denied.
What it does
Uses the TREMFYA withMe enrollment and prescription form to evaluate temporary subcutaneous product support while the clinic continues required plan access work.
Open official program pagePotentially available to eligible commercially insured patients prescribed subcutaneous TREMFYA whose coverage is delayed or denied.
Government program exclusions: Medicare, Medicaid, TRICARE, VA, DoD, Other federal or state healthcare programs
Complete all applicable patient, provider, prescription, and temporary-access sections.
Open documentAttach plan evidence requested by the program.
Continue plan-required prior authorization, medical exception, or appeal work.
The clinic submits the signed enrollment/prescription form and coverage-event evidence, then continues the required coverage process while TREMFYA withMe evaluates temporary product support.
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
Prescriber And Clinic Staff, TREMFYA WithMe, Patient, Health Plan, Authorized Pharmacy
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.
Prescriber completes the prescription, clinical, insurance, and service-selection sections and attaches supporting records.
Owner: Prescriber or clinic staff
Have ready: Patient authorization, Subcutaneous prescription, Insurance cards, Delay or denial evidence
Submit the completed form by fax to 1-844-322-9402.
Owner: Clinic staff
After enrollment: If approved, the program coordinates dispensing and tells the clinic what coverage work and reverification are required.
If there is a problem: Call before the next planned dose if the coverage decision or program shipment remains unresolved.
