Dosage & Administration Drug label Prior authorization Financial assistance

Simponi

(golimumab)

Simponi Aria 50 MG in 4 mL Injection

Dosage & administration

* Adult patients with Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis:
* 2 mg/kg intravenous infusion over 30 minutes at weeks 0 and 4, and every 8 weeks thereafter ( 2.1)

* Pediatric patients with polyarticular Juvenile Idiopathic Arthritis and Psoriatic Arthritis:
* 80 mg/m 2intravenous infusion over 30 minutes at weeks 0 and 4, and every 8 weeks thereafter ( 2.2)

* Dilution of supplied SIMPONI ARIA solution with 0.9% Sodium Chloride Injection, USP is required prior to administration. Alternatively, 0.45% Sodium Chloride Injection, USP can also be used ( 2.4)

drug label

Simponi prescribing information

Contact Medical Science Liaison Report Adverse Event

prior authorization

Simponi prior authorization resources

Most recent Simponi prior authorization forms

View By Payer

Verified: Oct 02, 2023Blue Cross Blue Shield of Michigan - FEP Simponi ARIA Prior Authorization Form (Medical Benefit)

Verified: Sep 28, 2023Cigna - Simponi Aria Prior Authorization Form

Verified: Sep 26, 2023Blue Cross Blue Shield of Michigan - Simponi ARIA Prior Authorization Form (Medical Benefit)

Verified: Sep 22, 2023Independence Health - Value Formulary Immune Modulating Therapy Prior Authorization Form

Verified: Sep 22, 2023Independence Health - Select Formulary Immune Modulating Therapy Prior Authorization Form

Verified: Sep 21, 2023Aetna - Simponi ARIA Prior Authorization Form

Verified: Sep 21, 2023Aetna - Medicare Part B Simponi Aria Prior Authorization Form

OTHERComplete Letter of Medical Necessity

PDFAppeals Checklist

PDFAppeals Checklist - Spanish

PDFFormulary Exceptions Checklist

PDFFormulary Exceptions Checklist - Spanish

OTHERFormulary Exception Letter

PDFPA Checklist

PDFPA Checklist - Spanish

Learn More

Benefits investigation

PDFBenefits Investigation Form

PDFJanssen Patient Support Program Patient Authorization Form

PDFJanssen Patient Support Program Patient Authorization Form - Spanish

Learn More

financial assistance

Simponi financial assistance options

Co-pay savings program

commercial only

Enroll in Patient Savings Program

Learn More

Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Foundation programs

under insured

no insurance

goverment insurance

65+

Johnson & Johnson Patient Assistance Foundation (JJPAF) - Eligibility Check

Learn More

Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and co-pays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement

patient education

Simponi patient education

Getting started on Simponi

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link