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Get Rebate Form
How it works
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Open form follow the instructions
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Easily sign the form with your finger
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Send filled & signed form or save
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
- Press the ‘Get Form’ button to access the Rebate Form. This will allow you to open the form in the designated editor.
- Provide your personal information in the specified fields, including your name, address, city, state, ZIP code, phone number, and email.
- Enter your member number from your activated StelaraSupport™ Instant Savings Card in the appropriate field.
- 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.
- If your doctor obtained ® for you, include the original Explanation of Benefits (EOB) from your insurance company.
- Sign and date the form, as your signature is required for processing the rebate.
- Review all entered information for accuracy.
- 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!
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.
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