Stable on Tremfya for psoriasis? Fight for continued coverage.

Fight Your Tremfya Formulary Removal

Express Scripts is excluding Tremfya in 2026 — but you can appeal for continuity of care.

Understanding Your Tremfya (Guselkumab) Continuity of Care Denial

Express Scripts is excluding Tremfya from the National Preferred Formulary in 2026. If you have psoriasis or psoriatic arthritis and are stable on Tremfya, you have rights under federal continuity of care regulations.

Common Reasons for Denial

! Tremfya excluded from formulary
! Plan requires switch to alternative biologic
! Step therapy required before Tremfya
! Prior authorization now required
! Non-formulary exception denied

How We Help

We help you document your treatment history with Tremfya, explain why switching biologics may trigger disease flares, and cite federal and state laws that protect stable patients from forced medication changes.

Start your Tremfya continuity of care appeal.

Some Types of Evidence We Can Use For Supporting Your Appeal

✓ Guselkumab (Tremfya) selectively targets IL-23, showing high rates of skin clearance in plaque psoriasis and efficacy in psoriatic arthritis.

✓ Switching biologics in psoriasis can result in disease flare and may not achieve the same level of clearance as the original medication.

Financial Assistance Directory

Curated copay foundations, manufacturer programs, and safety-net clinics that may help with the cost while you appeal.

For your condition

National Psoriasis Foundation Patient Navigation (opens in a new tab)

Free 1-on-1 help with insurance access, prior auth, and copay assistance for psoriasis and psoriatic arthritis.

General copay foundations & directories

NeedyMeds (opens in a new tab)

Searchable database of 5,000+ patient assistance, copay, and diagnosis-specific programs. Start here if you are not sure where to look.

Eligibility: No eligibility check - the directory itself is free. Individual programs have their own income and insurance criteria.

Patient Advocate Foundation Co-Pay Relief (opens in a new tab)

Direct copay assistance for insured patients with chronic, life-threatening, or rare conditions. Covers many disease funds.

Eligibility: Generally requires insurance coverage and income up to 400% of the federal poverty level (varies by fund).

Phone: 1-866-512-3861

HealthWell Foundation (opens in a new tab)

Independent charity providing copay, premium, and travel assistance grants across 70+ disease funds.

Eligibility: Must have insurance covering the prescribed treatment; income thresholds vary by fund. Funds open and close as donations allow.

The Assistance Fund (TAF) (opens in a new tab)

Copay, insurance premium, and travel assistance for patients with chronic and rare diseases.

Eligibility: Must have insurance and meet income limits (typically up to 500% FPL, fund-dependent).

Good Days (opens in a new tab)

Copay assistance and other support for chronic-disease patients.

Eligibility: Funds vary by disease and open/close based on availability. Usually requires insurance and income under ~500% FPL.

PAN Foundation (Patient Access Network) (opens in a new tab)

Disease-specific copay assistance funds for ~70 conditions. Funds open and close throughout the year - check the website or sign up for fund-open alerts.

Eligibility: Insurance required; income limits typically 400-500% of FPL depending on the fund.

NORD (National Organization for Rare Disorders) (opens in a new tab)

Patient assistance, copay, and travel programs for people living with rare diseases.

RxAssist Patient Assistance Program Center (opens in a new tab)

Comprehensive directory of manufacturer patient assistance programs. Search by medication to find the manufacturer's free-drug program if you are uninsured or under-insured.

Safety-net clinics & 340B

HRSA Find a Health Center (FQHC locator) (opens in a new tab)

Federally Qualified Health Centers (FQHCs) provide primary care on a sliding-fee scale and dispense many medications at 340B-discounted prices, regardless of insurance status. Often the cheapest path for uninsured or under-insured patients.

HRSA 340B Program (provider directory + program info) (opens in a new tab)

Background on the 340B Drug Pricing Program. Use to verify whether a particular clinic or hospital is a covered entity before assuming discounted pricing applies.

State Pharmaceutical Assistance Program (SPAP) directory (opens in a new tab)

State-run programs (mostly for seniors and people with disabilities) that supplement Medicare Part D and reduce prescription costs. Availability and benefits vary by state.

Medicaid eligibility & application (Healthcare.gov) (opens in a new tab)

If denied insurance is unaffordable, check Medicaid / CHIP eligibility - thresholds and pathways vary by state, and many expansion states cover adults up to 138% FPL.

Program eligibility, fund availability, and contact info change frequently. Verify with each organization before assuming a program is open.

Patient Assistance & Copay Programs

These programs may help reduce your costs while you appeal:

Janssen CarePath Savings Program

Eligible patients with commercial insurance may pay as little as $5 per dose. Not for government insurance.

Johnson & Johnson Patient Assistance Foundation

Patient assistance for uninsured or underinsured patients who meet income requirements.

Eligibility requirements and program terms may change. Please verify current details directly with each organization.

Patient Advocacy & Support Organizations

These organizations provide education, support, and advocacy for patients:

National Psoriasis Foundation

Patient-centric nonprofit driving research and improving lives of those with psoriatic disease.

Ready to Fight Your Tremfya (Guselkumab) Continuity of Care Denial?

Our free AI-powered tool will help you generate a compelling appeal letter in minutes.

Start Your Appeal Chat with AI Assistant

Disclaimer: Fight Health Insurance is not affiliated with, endorsed by, or partnered with any pharmaceutical manufacturer, healthcare provider, medical device company, or patient assistance program. All information provided is for educational and informational purposes only and does not constitute medical or legal advice. Please consult with your healthcare provider regarding treatment options and with your insurance company regarding coverage decisions.