Resources for you and your practice
The following downloads, links, and forms can help you and your practice navigate the treatment course with Jelmyto.
Support and Affordability
A brochure dedicated to services provided by UroGen SupportTM.
Scheduling and Ordering Resource
A brochure outlining the 4 simple steps to getting started with Jelmyto.
Return Goods Overview
A visual summary of the return goods process for JELMYTO.
How to Bill Jelmyto Guide
See preparation and instillation quantities for Jelmyto and learn what is required for accurate billing and sufficient reimbursement.
Jelmyto Product Fact Sheet
Information about Jelmyto including NDC, WAC, support, and distributor information.
Price Increase Announcement
Information about the Jelmyto WAC increase.
UroGen® Return Goods Policy
A comprehensive resource on returned goods including eligible returns, credit and reimbursement, and return procedure.
Practice Forms and Documents
Credit Request Form
Initiate a credit request to your account.
Account Setup Form
Affirm your account or set up a new account with Cardinal Health SPD.
Account Setup Checklist
Key information to help navigate the account setup process.
Prior Authorization Checklist
Provides information that is generally used to determine medical necessity by payer.
Claims Submission Checklist
Key information to help navigate the claims submission process.
Letter of Medical Necessity
Customizable letter supporting Jelmyto use in appropriate patients.
Customizable letter of appeal for denial of coverage.
Jelmyto Resources and Downloads
AUA/SUO and NCCN Guidelines for Jelmyto
An overview of each organization's recommendation of kidney-sparing treatment for low-grade UTUC and how Jelmyto fits in.
Jelmyto Enhanced Media Kit
Communication starter kit to help educate staff and surrounding practices on Jelmyto.
Jelmyto Clinical Story
Key information about the clinical trial, administration, and additional resources.
Multimodal Treatment Algorithm
Access which treatment option is right for your patient with low-grade UTUC.
Profile of a patient with unresectable, primary disease.
Profile of a patient with advanced age and comorbidities.
Profile of a patient with recurrence after endoscopic management.
Profile of a patient with bilateral disease.
Antegrade Instillation Overview
Clinical considerations and real-world study experience from multiple practice sites.
Nephrostomy Order Form
Request for nephrostomy tube placement with kidney volume measurement.