Remistart 2025

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4.9 out of 5

578 votes

The document is a Patient Enrollment Form for the RemiStart® Patient Rebate Program, designed to assist patients with the costs of REMICADE® medication. It outlines eligibility requirements, including the necessity of having private or commercial health insurance and not seeking reimbursement from government-subsidized programs. The form collects patient information, insurance details, and requires patient authorization for sharing medical information with Janssen Biotech, Inc. The program aims to provide financial assistance through a rebate card or check for eligible patients.

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Click ‘Get Form’ to open the remistart document in the editor.
Begin by filling out the 'Patient Information' section. Enter your name, gender, address, city, state, zip code, primary phone number, date of birth, and email address.
Indicate your preference for receiving the rebate by selecting either 'Mail Check to Me' or 'Mail Check to Infusion Provider'.
Complete the 'Insurance Information' section. Provide details about your primary insurance company, prescription insurance name, and relevant policy numbers as indicated.
Review the eligibility questions regarding your health insurance coverage and confirm your understanding by selecting 'Yes' or 'No' as appropriate.
Sign and date the form at the bottom to certify that all information is accurate. If necessary, have a personal representative sign on behalf of the patient.
Finally, fax or mail the completed enrollment form to RemiStart® using the provided contact information.

Start filling out your remistart form today for free and streamline your enrollment process!

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Versions	Form popularity	Fillable & printable
2016	4.9 Satisfied (578 Votes)
2015	4.4 Satisfied (181 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does REMICADE have a patient assistance program?

Support for patients using commercial or private insurance to pay for medication. Your eligible patients pay as little as $5 per infusion for their REMICADE medication. Maximum program benefit per calendar year shall apply. Savings may apply to co-pay, co-insurance, or deductible.

What is the phone number for REMICADE copay assistance?

Depending on what youre treating, you may be on Remicade for several weeks to several months. For some conditions like IBD, you may need to be on Remicade for the long term, in which case youll need constant reassessment to confirm its continued efficacy.

Does Janssen Pharmaceuticals have a patient assistance program?

Janssen CarePath is a patient support program. It offers different savings options and resources at no cost to patients to help them learn about, afford, and stay on their medication.

How much does a REMICADE infusion cost without insurance?

Remicade may help reduce symptoms of flare-ups and lengthen the periods of time between flare-ups. Remicade costs between $4,000 and $7,000 without insurance, but Medicare Part B plans typically cover a portion of the cost, and there are other ways to save.

How long can you stay on REMICADE?

If your health plan does not approve REMICADE treatment For example, your health plan might not cover the medication because it is not on the plans drug list (formulary) or the cost is higher than you think you should have to pay.

form registration information

Janssen CarePath REMICADE Patient Assistance Program Johnson and Johnson

How does the Janssen CarePath Savings Program work?

Get instant savings on your out-of-pocket costs for your medicine from Johnson Johnson. Depending on your health insurance plan, savings may apply toward co-pay, co-insurance, or deductible. Maximum program benefit per calendar year shall apply. Terms expire at the end of each calendar year.

Does Janssen CarePath work with Medicare?

Janssen CarePath can help Medicare patients with Benefits Investigations, Prior Authorization support, and information on cost support programs. Learn about the different parts of Medicare. Also see what it may cover, including medications.