Support for BALVERSA®
BALVERSA® is covered*
Coverage for patients with Medicare
Coverage for patients with commercial insurance
*Source: Managed Markets Insight & Technology, LLC, a trademark of MMIT, as of [August 2023]. These percentages may not represent 100% of formulary lives due to data limitations.
The information provided is not a guarantee of coverage or payment (partial or full). Actual benefits are determined by each plan administrator in accordance with its respective policy and procedures. This content is presented for informational purposes only and is not intended to provide reimbursement or legal advice, nor does it promise or guarantee coverage, levels of reimbursement, payment, or charge. It is not intended to increase or maximize reimbursement by any payer. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. While we have made an effort to be current as of the issue date of this content, the information may not be as current or comprehensive when you view it. Please contact the plan for more information about coverage or any restrictions or prerequisites that may apply. We strongly recommend you consult the payer organization for its reimbursement policies. All information is subject to change.
Specialty Distributor and Specialty Pharmacy Flashcard
See specialty distributor and specialty pharmacy information for access to BALVERSA®, in addition to services provided by CVS Specialty®.
Access Support
To help you get your patients started on BALVERSA®, the following resources may be helpful to your patients and your practice:
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Supporting Appropriate Payer Coverage Decisions
This brochure has been developed to help healthcare providers understand how to work with payers for coverage of medically necessary drug therapies.
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Extra Help with Prescription Drug Costs: Medicare Low-Income Subsidy (LIS) Overview
Learn about extra help available to low-income residents of the United States who are enrolled in Medicare Prescription Drug Plans.
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Know Your State Interactive Tool
This interactive tool provides information on affordability options for patients at the state level.
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Sample Exception Letter
Each payer follows a different process when filing exceptions and appeals. Submit an exception letter when requesting an exception for BALVERSA®.
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Sample Letter of Medical Necessity
Submit a letter to support the medical necessity of treatment with BALVERSA® either with the initial claim or when requesting reconsideration of a denied claim.
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Prior Authorization Considerations Checklist
Learn more about general Prior Authorization processes including items and information that may be requested from your patient’s insurer.
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Appeal Considerations Checklist
If your patient’s insurer denies coverage for your patient, learn more about general insurance appeals processes.
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Exception Considerations Checklist
General information on exception processes for your patient’s coverage of medically necessary drug therapies.
Affordability Support
Affordability Options for Prescription Drugs – This summary presents resources that may assist patients with their prescription drug costs based on their primary insurance status.
Support for patients using commercial or private insurance to pay for medication
Eligible commercially insured patients
Janssen CarePath Savings Program for BALVERSA® can help eligible patients receive instant savings on their out-of-pocket medication costs for BALVERSA®. Depending on their health insurance plan, savings may apply toward co-pay, co-insurance, or deductible. Your eligible patients will pay $5 per fill with a $25,000 maximum program benefit per year. 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. There is no income requirement. See full eligibility requirements at Balversa.JanssenCarePathSavings.com.
Providers can check patients’ eligibility and enroll them in the Janssen CarePath Savings Program for BALVERSA® at JanssenCarePathPortal.com/express. There is a "Print a Card" feature to provide the patient with a card.
Your patients and their caregivers can enroll the patient in the Janssen CarePath Savings Program for BALVERSA® at MyJanssenCarePath.com/express.
Support for patients using government-funded healthcare programs or patients without insurance coverage
Patients without commercial or private health insurance may find help from the programs and resources found on JanssenCarePath.com.
Patient Assistance for Insured Patients Facing Access and Affordability Challenges
Patient assistance from Janssen is available if your patient has commercial, employer-sponsored, or government coverage that does not fully meet their needs. Your patient may be eligible to receive their Janssen medication free of charge for up to one year if they meet the eligibility and income requirements for the Janssen Patient Assistance Program. See terms and conditions at PatientAssistanceinfo.com.
Treatment Support
Advocacy Connector
AdvocacyConnector.com is a Janssen-sponsored resource that connects patients and caregivers to national and state-specific advocacy groups that offer resources.
Other Resources
The Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF) is an independent, nonprofit organization. JJPAF gives eligible patients free prescription medicines donated by Johnson & Johnson companies. Patients may be eligible if they don’t have insurance. Do you have patients who may need help? They can see if they are eligible and get an application at JJPAF.org or call 800-652-6227 (Monday through Friday, 8:00 AM to 8:00 PM ET).
