Helpful Resources for Infliximab
*Savings Program for patients with commercial or private insurance coverage.
Infliximab Website
Infliximab.com
This website contains additional information about treatment with Infliximab.
Authorization
Patient Authorization Form [PDF]
Allows you to authorize your Healthcare Providers to use and share your medical information with the patient support programs offered by Johnson & Johnson.
Gastroenterologist Patient Enrollment Form [PDF]
A way to find out if Infliximab is covered by the patient's insurance plan, including requirements for coverage or prior, any out-of-pocket costs, and approved pharmacies.
Non-Gastroenterology Patient Enrollment Form [PDF]
A way to find out if Infliximab is covered by the patient's insurance plan including requirements for coverage or prior authorization, any out-of-pocket costs, and approved pharmacies, if rheumatology or dermatology treatment is needed for patient.
Cost Support
J&J withMe Savings Program Overview [PDF]
Provides information on the J&J withMe Savings Program for Infliximab and eligibility requirements for enrolling in the program.
J&J withMe Savings Program Rebate Form [PDF]
Allows you to request a rebate for your medicine cost. Rebate requests can also be submitted in your online account at Account.JNJwithMe.com.
Patient Affordability Options for Infliximab [PDF]
Gives information on options that can make your treatment more affordable.
Coverage
Health Insurance Open Enrollment Guide [PDF] Health Insurance Open Enrollment Guide [PDF] (en español)
Even if you keep the same health plan, your benefits can change. This guide can help you review your coverage and make changes if needed during the open enrollment period so you can stay on treatment in the new benefit period.
Medicare Resource Guide [PDF] Medicare Resource Guide [PDF] (en español)
Provides information on sources for cost support that may be available to patients enrolled in Medicare.
Medicare Low-Income Subsidy (LIS) Brochure [PDF]
Offers information about extra help with prescription drug costs that is available to low-income residents of the United States enrolled in Medicare Prescription Drug Plans.
Medicare Low-Income Subsidy (LIS) "Extra Help" Resource for Patients [PDF] Medicare Low-Income Subsidy (LIS) "Extra Help" Resource for Patients [PDF] (en español)
Helps you learn if you qualify for this Medicare program.