UroGen Support

Here to help patients get access to JELMYTO

We know getting patients access to JELMYTO is a crucial step in their treatment. To make this process as simple as possible, UroGen Support provides:

  • Comprehensive access and reimbursement support
    • Benefits investigations
    • Prior authorization and coverage appeal process assistance
    • Billing and coding assistance
    • Patient affordability and financial assistance for eligible patients. Additional restrictions and limitations may apply
  • Product acquisition and preparation coordination

UroGen Support

Need help? Contact us.

1-855-JELMYTO (1-855-535-6986)

Monday-Friday, 8 AM–8 PM ET

Overview of key steps

STEP
1

Provider enrolls patient in UroGen Support Program for JELMYTO

STEP
2

UroGen Support conducts benefits investigation, identifies potential prior authorization requirements, and determines eligibility for financial support options

STEP
4

JELMYTO is administered to the patient

STEP
3

UroGen Support and provider coordinate product acquisition, preparation, and delivery

STEP
4

JELMYTO is administered to the patient

Get started now

Enrollment Form

This enrollment form must be completed and signed by the prescriber and patient and emailed or faxed to UroGen Support at Contact@UroGenSupport.com or 833-664-7216 in order for UroGen Support to provide assistance.Download iconDownload

Download Coding & Billing Guide

Billing and Coding Guide

This resource includes necessary billing and coding information for JELMYTO processing and reimbursement.Download iconDownload

Download Coding & Billing Guide

Billing and Coding Guide

This resource includes necessary billing and coding information for JELMYTO processing and reimbursement.Download iconDownload

Download Affordability Brochure

Affordability Brochure

UroGen Support is committed to helping patients get access to JELMYTO. This resource outlines the financial assistance programs that are available for eligible patients who have been prescribed JELMYTO. The appropriate program will depend on the patient's coverage.Download iconDownload


Additional resources

Declaration Letter

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PA and Appeals Checklist

PA and Appeals Checklist

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PA and Appeals Checklist

PA and Appeals Checklist

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Program Overview Brochure

Program Overview Brochure

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Claims Submission Checklist

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Letter of Medical Necessity

Letter of Medical Necessity

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Letter of Medical Necessity

Letter of Medical Necessity

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Appeals Letter

Appeals Letter

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JELMYTO Formulary Kit

JELMYTO Formulary Kit

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Approved Use for JELMYTO

JELMYTO™ is a prescription medicine used to treat adults with a type of cancer of the lining of the upper urinary tract including the kidney called low-grade Upper Tract Urothelial Cancer (LG-UTUC).

Important Safety Information

You should not receive JELMYTO if you have a hole or tear (perforation) of your bladder or upper urinary tract.

Before receiving JELMYTO, tell your healthcare provider about all your medical conditions, including if you

  • are pregnant or plan to become pregnant. JELMYTO can harm your unborn baby. You should not become pregnant during treatment with JELMYTO. Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with JELMYTO.
    Females who are able to become pregnant: You should use effective birth control (contraception) during treatment with JELMYTO and for 6 months after the last dose.
    Males being treated with JELMYTO: If you have a female partner who is able to become pregnant, you should use effective birth control (contraception) during treatment with JELMYTO and for 3 months after the last dose.
  • are breastfeeding or plan to breastfeed. It is not known if JELMYTO passes into your breast milk. Do not breastfeed during treatment with JELMYTO and for 1 week after the last dose.
  • Tell your healthcare provider if you take water pills (diuretic).

How will I receive JELMYTO?

  • Your healthcare provider will tell you to take a medicine called sodium bicarbonate before each JELMYTO treatment.
  • You will receive your JELMYTO dose from your healthcare provider 1 time a week for 6 weeks. It is important that you receive all 6 doses of JELMYTO according to your healthcare provider’s instructions. If you miss any appointments, call your healthcare provider as soon as possible to reschedule your appointment. Your healthcare provider may recommend up to an additional 11 monthly doses.
  • JELMYTO is given to your kidney through a tube called a catheter.
  • During treatment with JELMYTO, your healthcare provider may tell you to take additional medicines or change how you take your current medicines.

After receiving JELMYTO:

  • JELMYTO may cause your urine color to change to a violet to blue color. Avoid contact between your skin and urine for at least 6 hours.
  • To urinate, males and females should sit on a toilet and flush the toilet several times after you use it. After going to the bathroom, wash your hands, your inner thighs, and genital area well with soap and water.
  • Clothing that comes in contact with urine should be washed right away and washed separately from other clothing.

JELMYTO may cause serious side effects, including:

  • Swelling and narrowing of the tube that carries urine from the kidney to the bladder (ureteric obstruction). If you develop swelling and narrowing, and to protect your kidney from damage, your healthcare provider may recommend the placement of a small plastic tube (stent) in the ureter to help the kidney drain. Tell your healthcare provider right away if you develop side pain or fever during treatment with JELMYTO.
  • Bone marrow problems. JELMYTO can affect your bone marrow and can cause a decrease in your white blood cell, red blood cell, and platelet counts. Your healthcare provider will do blood tests prior to each treatment to check your blood cell counts during treatment with JELMYTO. Your healthcare provider may need to temporarily or permanently stop JELMYTO if you develop bone marrow problems during treatment with JELMYTO.

The most common side effects of JELMYTO include: side pain, urinary tract infection, blood in your urine, kidney problems, tiredness, nausea, stomach pain, trouble with urination, vomiting, low red blood cell count, frequent urination, itching, chills, and fever.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch or call 1-800-FDA-1088. You may also report side effects to UroGen Pharma at 1-855-987-6436.

Please click here for JELMYTO Full Prescribing Information, including the Patient Information, for additional information.

Please click here for Full Prescribing Information, Instructions for Pharmacy and Instructions for Administration.