Indication & Important Safety Information
Prescribing Information
Need Help?

Janssen CarePath Savings Program

Express Enrollment

Welcome to the Express Enrollment Site for the Janssen CarePath Savings Program

Please make a selection

I am a patient

I am a caregiver

This form is intended to be used by a member of a patient's "Care Team," which includes individuals who provide care for a patient and have permission from the patient to assist with patient enrollment in the Janssen CarePath Savings Program and activation of a card. This form is intended to be used by patients enrolling in the Janssen CarePath Savings Program and activating a card. The information you provide will be used by Johnson & Johnson Health Care Systems Inc., our affiliates, and our service providers ("Janssen CarePath") to determine youra patient's eligibility for the Janssen CarePath Savings Program indicated below, and to provide benefits to youthem related to the activation and use of the Janssen CarePath Savings Program Card. We may also use the information you provide to learn more about the people who use Janssen CarePath resources and to improve the information we provide to people who are enrolled in Janssen CarePath programs. The information you provide will be shared with companies supporting the program and as required by law. Our Privacy Policy further governs the use of information you provide. By providing the information and selecting the Submit button, you indicate that you read, understand, and agree with these terms.

ProductTherapy Prescribed

Select the product prescribed or being considered for this patient.

Select the product you and your doctor have determined is right for you.

BALVERSA® (erdafitinib)

INVOKAMET® XR (canagliflozin/
metformin HCl extended-release)

SYMTUZA® (darunavir/cobicistat/
emtricitabine/tenofovir alafenamide)

EDURANT® (rilpivirine)

INVOKANA® (canagliflozin)

TREMFYA® (guselkumab)

ERLEADA® (apalutamide)

PREZCOBIX® (darunavir 800 mg /
cobicistat 150 mg)

XARELTO® (rivaroxaban)

INTELENCE® (etravirine)

PREZISTA® (darunavir)

ZYTIGA® (abiraterone acetate)

INVOKAMET® (canagliflozin/
metformin HCl)

SIMPONI® (golimumab)

Learn more about the Janssen CarePath Savings Program, including full eligibility requirements for:
BALVERSA®, EDURANT®, ERLEADA®, INTELENCE®, INVOKAMET®, INVOKAMET® XR, INVOKANA®, PREZCOBIX®, PREZISTA®, SIMPONI®, SYMTUZA®, TREMFYA®, XARELTO®, and ZYTIGA®

Patient Information

First Name

MI (Optional)

Last Name

Suffix (Optional)

Date of Birth

You must be at least 18 years old or ask your caregiver to register on your behalf.

Patient must be at least years old to be enrolled in the Savings Program for .

Sex

Email (Optional)

Phone

Address

Address (Line 2 - Optional)

City

State

Zip

Please enter a valid address.

Patient's Savings Program Terms and Conditions

By confirming and submitting this information, I certify that I have completed all of the previous sections completely, accurately, and to the best of my knowledge, and that I have read, understand, and agree to the Terms and Conditions of the Janssen CarePath Savings Program for on behalf of the patient.

I conﬁrm that I have read, understood and agree to the Terms and Conditions of the Janssen CarePath Savings Program for . I am a caregiver for the patient identified above. I am a member of the care team for the patient identified above. I have reviewed the program eligibility and other requirements with the patient and received the patient's authorization to activate a Janssen CarePath Savings program on their behalf.

I acknowledge I have provided my patient with the full eligibility requirements for the Janssen CarePath Savings Program for .

You have successfully enrolled this patient in the Janssen CarePath Savings Program
and the patient's card is now activated and ready to print! You have successfully enrolled in the Janssen CarePath Savings Program
and your card is now activated and ready to print! You have successfully enrolled this patient in the Janssen CarePath Savings Program
and the patient's card is now activated and ready to print!

You have successfully enrolled this patient in the Janssen CarePath Savings Program
and the patient's card is now activated and ready to print! You have successfully enrolled in the Janssen CarePath Savings Program. You have successfully enrolled this patient in the Janssen CarePath Savings Program.

Card Information
Name:
Medication:
BIN:
Group:
Member ID:

Click on the button below to view the patient's card for printing.* If you do not print it, make note of the BIN, Group, and 11-digit Member ID numbers for future use. The patient may now use this card with a valid prescription at the pharmacy to receive instant savings on Print the patient's card, to save for their records, by clicking on the button below.* If you choose not to print the card, make note of the BIN, Group, and 11-digit Member ID numbers for future use. The patient may now use this card with a valid prescription at the pharmacy to receive instant savings on Print your card, to save for your records, by clicking on the button below.* If you choose not to print your card, make note of the BIN, Group, and 11-digit Member ID numbers for future use. You may now use this card with a valid prescription at the pharmacy to receive instant savings on BALVERSA® (erdafitinib). ERLEADA® (apalutamide). ZYTIGA® (abiraterone acetate). XARELTO® (rivaroxaban). TREMFYA® (guselkumab). SIMPONI® (golimumab).

*Requires Adobe® Reader®
Get Adobe Reader

Choose how you get your Janssen CarePath Savings Program card: Choose how you get the patient's Janssen CarePath Savings Program card:

1. Text/Mobile Wallet

Your mobile phone number

Request successfully submitted.
Please call Janssen CarePath if you have not received your card within 5 minutes.

Request unsuccessful, please try again or call Janssen CarePath.

Message and data rates may apply

Click here to view the Mobile Terms and Conditions.

2. Print or download PDF

*Requires Adobe® Reader® Get Adobe Reader

Print or write down BIN, Group, and Member ID listed in Card Information

You may now use this card with a valid prescription at the pharmacy to receive instant savings on
. The patient may now use this card with a valid prescription at the pharmacy to receive instant savings on
.

Need Help?
Call
Monday-Friday, 8:00 AM - 8:00 PM ET

Want to do more? Registering for the Janssen CarePath Provider Portal allows you to: Want to do more? Setting up a Janssen CarePath Account allows you to:

	Request benefits investigations and review the status Learn about your insurance coverage Learn about the patient's insurance coverage
	View savings program transactions for enrolled patients View savings program transactions
	Receive notifications when new information is available or action is required on the Portal Sign up for treatment support

We're sorry. We are not able to complete the patient's enrollment for the Janssen CarePath Savings Program.

This patient may not be eligible for the Janssen CarePath Savings Program since our records indicate they don't have commercial insurance. If you feel that this is an error, please call your Janssen CarePath Care Coordinator to help answer your questions and provide information on other programs that may help with your patient's out-of-pocket medication costs.

The patient is not eligible for the Janssen CarePath Savings Program for XARELTO® (rivaroxaban) because the program is not available to patients only being treated with XARELTO® 10 mg due to recently having undergone hip or knee replacement surgery.

Please call a Janssen CarePath Care Coordinator to help answer your questions and provide information on other programs that may help the patient with medication out-of-pocket costs.

The patient is not eligible for the Janssen CarePath Savings Program for XARELTO® (rivaroxaban) because the program is not available to patients prescribed XARELTO® 10 mg due to a recent non-surgical hospitalization.

Please call a Janssen CarePath Care Coordinator to help answer your questions and provide information on other programs that may help the patient with medication out-of-pocket costs.

Call
Monday-Friday, 8:00 AM - 8:00 PM ET

We're sorry. We are not able to complete the patient's enrollment for the Janssen CarePath Savings Program.

The patient may not be eligible for the Janssen CarePath Savings Program since our check of a third-party database indicates the patient has government coverage.

If the patient has other commercial or private health insurance that they intend to use for this medication, please call a Janssen CarePath Care Coordinator to provide that information, mentioning code EFC. You may also contact us to help answer your questions and provide information on other programs that may help with Janssen medication out-of-pocket costs.

Call
Monday-Friday, 8:00 AM - 8:00 PM ET

We're sorry. We are not able to complete your enrollment for the Janssen CarePath Savings Program.

You may not be eligible for the Janssen CarePath Savings Program since our check of a third-party database indicates you have government coverage.

If you have commercial or private health insurance that you intend to use for this medication, please call
to provide that information.

Based on your answer, you are not eligible for the Janssen CarePath Savings Program for XARELTO® (rivaroxaban) because the program is not available to patients only being treated with XARELTO® 10 mg due to recently having undergone hip or knee replacement surgery.

Please call a Janssen CarePath Care Coordinator to help answer your questions and provide information on other programs that may help with Janssen medication out-of-pocket costs.

Based on your answer, you are not eligible for the Janssen CarePath Savings Program for XARELTO® (rivaroxaban) because the program is not available to patients only being treated with XARELTO® 10 mg due to a recent non-surgical hospitalization.

Please call a Janssen CarePath Care Coordinator to help answer your questions and provide information on other programs that may help with Janssen medication out-of-pocket costs.

Need Help?
Call
Monday-Friday, 8:00 AM - 8:00 PM ET

Want to do more? Registering for the Janssen CarePath Provider Portal allows you to: Want to do more? Setting up a Janssen CarePath Account allows you to:

	Request benefits investigations and review the status Learn about your insurance coverage Learn about the patient's insurance coverage
	View savings program transactions for enrolled patients View savings program transactions
	Receive notifications when new information is available or action is required on the Portal Sign up for treatment support

Please read the full Prescribing Information for the listed products at the top of the page and discuss any questions you have with your doctor. Please see full Prescribing Information for listed products at the top of the page.

Need Help?

Have questions about the Janssen CarePath Portal?

A Janssen CarePath Care Coordinator can help you navigate the Portal and find the resources you need.

Call 877-CarePath (877-227-3728)

Monday – Friday 8AM – 8PM ET

877-CarePath (877-227-3728), Monday - Friday, 8:00 AM - 8:00 PM ET

Capitalized product names are trademarks of Johnson & Johnson or its affiliated companies.

This site is intended for use by healthcare professionals in the United States.

Third-party trademarks used herein are trademarks of their respective owners.

Last updated on February 1, 2020.

The use of the information on this site is subject to the terms of our Legal Terms of Use and Privacy Policy.

Legal Terms of Use | Privacy Policy | Contact Us

Janssen CarePath Savings Program

Express Enrollment

Welcome to the Express Enrollment Site for the Janssen CarePath Savings Program

We're sorry. We are not able to complete the patient's enrollment for the Janssen CarePath Savings Program.

We're sorry. We are not able to complete the patient's enrollment for the Janssen CarePath Savings Program.

We're sorry. We are not able to complete your enrollment for the Janssen CarePath Savings Program.

Please read the full Prescribing Information for the listed products at the top of the page and discuss any questions you have with your doctor. Please see full Prescribing Information for listed products at the top of the page.

Please read the full Prescribing Information and Patient Information for BALVERSA®, and discuss any questions you may have with your doctor. Please see the full Prescribing Information and Patient Information for BALVERSA®.

We're working on your enrollment request.