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  • Rebate Form

Get Rebate Form

The Janssen Biotech Instant Savings Program Support System Rebate Form In some cases, your StelaraSupport Instant Savings Card may not be accepted. Submit this form if: Your pharmacy cannot process.

How it works

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How to fill out the Rebate Form online

This guide is designed to help you effectively complete the Rebate Form online. Whether you are a first-time user or have some familiarity with rebate forms, our step-by-step instructions will ensure you provide all necessary information accurately.

Follow the steps to complete your Rebate Form online

  1. Press the ‘Get Form’ button to access the Rebate Form. This will allow you to open the form in the designated editor.
  2. Provide your personal information in the specified fields, including your name, address, city, state, ZIP code, phone number, and email.
  3. Enter your member number from your activated StelaraSupportâ„¢ Instant Savings Card in the appropriate field.
  4. If your pharmacy could not process your Instant Savings Card, attach the original pharmacy receipt. Make sure to circle the product name, the date of purchase, and the amount paid. Ensure that the receipt includes your name, the date, and the amount.
  5. If your doctor obtained ® for you, include the original Explanation of Benefits (EOB) from your insurance company.
  6. Sign and date the form, as your signature is required for processing the rebate.
  7. Review all entered information for accuracy.
  8. Once completed, you may download, print, and share the form as needed, and then mail it to the address given on the form.

Complete your Rebate Form online today to receive your savings!

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Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

Visit www.fda.gov/medwatch or call 1-800-FDA-1088. For any questions you may have about ®, including how ® works, dosing, or cost savings and insurance, call Janssen CarePath for ® at 877-CarePath (877-227-3728), Monday-Friday, 8 AM to 8 PM ET.

The list price of ®is $12,332 per month, but most patients pay between $0 and $5 per month. 1. Actual out-of-pocket costs may vary based on dosing, indication, site of care, insurance coverage, and your eligibility for support programs. Contact your insurance provider for more details on your individual plan.

Call a Janssen CarePath Care Coordinator at 877-CarePath (877-227-3728), and ask about the Janssen CarePath Savings Program for ®. Your out-of-pocket medication costs could be just $5 per dose, with a $20,000 annual maximum benefit per calendar year.

Janssen Biotech, Inc. discovered ® and has exclusive marketing rights to the product in the United States. The Janssen Pharmaceutical Companies maintain exclusive worldwide marketing rights to ®, which is currently approved for the treatment of moderate to severe plaque psoriasis in 74 countries.

The first dose of ® is an induction dose, administered intravenously, under the supervision of a healthcare professional. Subsequent maintenance doses are administered as a subcutaneous injection every 8 weeks, either by a healthcare professional or self-injected by the patient after proper training.

® is a prescription medicine used to treat: adults and children 6 years and older with moderate or severe psoriasis who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).

IF YOU ARE COVERED AND HAVE A CO-PAY, CO-INSURANCE, OR DEDUCTIBLE: You may qualify for out-of-pocket assistance. Call a Janssen CarePath Care Coordinator at 877-CarePath (877-227-3728), and ask about the Janssen CarePath Savings Program for ®.

While 96% of insurance plans cover the most common version of at a co-pay of $32.50-$80.00, many of them have restrictions. Manufacturer and pharmacy coupons can help offset the cost.

You may qualify for out-of-pocket assistance. Call a Janssen CarePath Care Coordinator at 877-CarePath (877-227-3728), and ask about the Janssen CarePath Savings Program for ®. Your out-of-pocket medication costs could be just $5 per dose, with a $20,000 annual maximum benefit per calendar year.

The list price of ®is $12,332 per month, but most patients pay between $0 and $5 per month. 1. Actual out-of-pocket costs may vary based on dosing, indication, site of care, insurance coverage, and your eligibility for support programs. Contact your insurance provider for more details on your individual plan.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232