Once you have made the clinical decision to prescribe BALVERSA®, Johnson & Johnson has resources to help you support your patients
BALVERSA® is covered for a majority of patients*
*Source: Managed Markets Insight & Technology, LLC, a trademark of MMIT, as of November 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 document 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 document, 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.
Ordering from CVS Specialty
BALVERSA® is accessible through Specialty Distributors ASD Healthcare® (1.800.746.6273) and Oncology
Supply® (1.800.633.7555) and the specialty pharmacy. To request BALVERSA® for your patient, please call
1.855.539.4712 or download the CVS Specialty® Enrollment Form by visiting CVSSpecialty.com and submit the completed form to CVS Specialty® via fax to 1.888.435.1256.
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®.
Patient Support for BALVERSA®
BALVERSA® is dispensed by a specialty pharmacy. Specialty pharmacies are equipped to facilitate product fulfillment and patient support. Specialty pharmacies may offer services to verify insurance coverage, identify potential patient assistance programs, and provide additional information to patients to increase adherence.
Access Support to Help Navigate Payer Processes
To help get your patients started on BALVERSA®, the following resources may be helpful to your patients and your practice. These resources are also available at JNJwithMe.com
- Prior Authorization Considerations Checklist
Learn more about general Prior Authorization processes including items and information that may be requested from your patient’s insurer.
- Appeal Considerations Checklist
If your patient’s insurer denies coverage for your patient, learn more about general insurance appeals processes.
- Exception Considerations Checklist
General information on exception processes for your patient’s coverage of medically necessary drug therapies.
- 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.
- Know Your State Interactive Tool
This interactive tool provides information on affordability options for patients at the state level.
Affordability Support
For patients using commercial or private insurance to pay for their medicine
J&J withMe Savings Program
Eligible patients can get 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. Eligible patients pay $5 per fill. Maximum program benefit per calendar year shall apply. 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. Offer subject to change or end without notice. Restrictions, including monthly maximums, may apply. Patients may participate without sharing their income information. See program requirements at Balversa.JNJwithMeSavings.com.
Providers can check patients’ eligibility and enroll them in the J&J withMe Savings Program at Portal.JNJwithMe.com. There is a "Print a Card" feature to provide the patient with a card.
Your patients and their care partners can enroll the patient in the J&J withMe Savings Program at Account.JNJwithMe.com.
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 JNJwithMe.com/Balversa. If they need help, patients may call
866-378-1910, Monday through Friday, 8:00 AM to 8:00 PM ET.
The patient support and resources provided by J&J withMe are not intended to provide medical advice, replace a treatment plan from the patient’s doctor or nurse, provide case management services, or serve as a reason to prescribe BALVERSA®.
Johnson & Johnson Patient Assistance Program
Patient assistance from Johnson & Johnson is available if your patient is uninsured or has commercial, employer-sponsored, or government coverage that does not fully meet their needs. Your patient may be eligible to receive their medicine from J&J at no cost for up to one year if they meet the eligibility and income requirements for the Johnson & Johnson Patient Assistance Program. See terms and conditions at PatientAssistanceInfo.com or en español at PatientAssistanceInfo.com/ES.