Effective January 1, 2021Permanent J code: J9281Download Billing and Coding Guide

Here to help patients get access to JELMYTO

With a dedicated team and end-to-end support, we're here to make the access, reimbursement, and coordination process as simple as possible for you and your patients.

OUR COMPREHENSIVE SUITE OF SUPPORT OFFERINGS*

magnifying glass icon

Conduct Benefits Investigations to confirm patient coverage details.

piggy bank icon

Determine patient affordability and financial assistance for eligible patients.

speech bubbles icon

Facilitate communications when prior authorization and coverage appeal process assistance are needed.

delivery truck icon

Coordinate with you and the pharmacy on product acquisition, preparation, and delivery.

J9281

Offer billing and coding assistance — JELMYTO has pass-through status and a permanent J code.

support team icon

Provide a full support team of Territory Business Managers, Field Reimbursement Managers, and Clinical Nurse Educators.

*Additional restrictions and limitations may apply.

Need help? Contact us.

1-855-JELMYTO (1-855-535-6986)
Monday-Friday, 8 AM–8 PM ET

See real-world reimbursement experience

Two administrative leads talk about the coverage, coding, and payment process at their own institutions

HOPD setting: Watch video
Community setting:
Watch video

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
3

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

Step
4

Jelmyto is administered to the patient

Get started now

preview of patient enrollment form

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 Coding & Billing Guide

Billing and Coding Guide

This resource includes necessary billing and coding information forJelmyto processing and reimbursement.

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.

Videos: Reimbursement experience

HOPD setting

Jacob Kettle, PharmD, BCOP and Director, Ellis Fischel Cancer Center, University of Missouri discusses reimbursement for Jelmyto in the hospital setting.

Community setting

Dr. Jason Hafron, Chief Medical Officer, Michigan Institute of Urology discusses reimbursement for Jelmyto in the community setting.

Additional resources

preview of Enhanced Media Kit

Enhanced Media Kit

preview of Returned Goods One Page Overview

Returned Goods One Page Overview

preview of JELMYTO Credit Request Form

Jelmyto Credit Request Form

preview of Scheduling and Ordering Resource

Scheduling and Ordering Resource

preview of declaration letter

Declaration Letter

PA and Appeals Checklist

PA and Appeals Checklist

Program Overview Brochure

Program Overview Brochure

preview of claim submission checklist

Claims Submission Checklist

Letter of Medical Necessity

Letter of Medical Necessity

Appeals Letter

Appeals Letter

Jelmyto Formulary Kit

Jelmyto Formulary Kit

Jelmyto J Code Brochure

Jelmyto J Code Brochure

Jelmyto Brand Story Leave Behind

Jelmyto Brand Story Leave Behind

Jelmyto Nephrostomy Instructions

Jelmyto Nephrostomy Instructions

UroGen Return Goods Policy

UroGen Return Goods Policy

Jelmyto price increase announcement

Price Increase Announcement

Multimodal Overview

Multimodal Overview

Patient Profile - Sidney

Patient Profile - Sidney

Patient Profile - Ted

Patient Profile - Ted

Patient Profile - Jon

Patient Profile - Jon

Patient Profile - Mia

Patient Profile - Mia

Need help? Contact us.

1-855-JELMYTO (1-855-535-6986)
Monday-Friday, 8 AM–8 PM ET

See real-world reimbursement experience

Two administrative leads talk about the coverage, coding, and payment process at their own institutions

HOPD setting: Watch video
Community setting:
Watch video
Full Prescribing InformationArrow (right) icon

Indications and Usage

Jelmyto® (mitomycin) for pyelocalyceal solution is indicated for the treatment of adult patients with low-grade Upper Tract Urothelial Cancer (LG-UTUC).

Important Safety Information

Contraindications

Jelmyto is contraindicated in patients with perforation of the bladder or upper urinary tract.

Ureteric Obstruction

Ureteric obstruction, including ureteral stenosis and hydronephrosis, occurred in patients receiving Jelmyto. Monitor patients for signs and symptoms of ureteric obstruction, including flank pain, and fever, and for changes in renal function. Patients who experience obstruction may require transient or long-term ureteral stents or alternative procedures. Withhold or permanently discontinue JELMYTO based on the severity of ureteric obstruction.

Bone Marrow Suppression

The use of Jelmyto can result in bone marrow suppression, particularly thrombocytopenia and neutropenia. The following tests should be obtained prior to each treatment: Platelet count, white blood cell count differential and hemoglobin. Withhold JELMYTO for Grade 2 thrombocytopenia or neutropenia. Permanently discontinue for Grade 3 or greater thrombocytopenia or neutropenia.

Embryo-Fetal Toxicity

Based on findings in animals and mechanism of action, Jelmyto can cause fetal harm when administered to a pregnant woman. In animal reproduction studies, administration of mitomycin resulted in teratogenicity. Advise females of reproductive potential to use effective contraception during treatment with JELMYTO and for 6 months following the last dose. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with JELMYTO and for 3 months following the last dose.

Common Adverse Reactions

The most common adverse reactions in ≥ 20% of patients treated with Jelmyto were ureteric obstruction, urinary tract infection, hematuria, flank pain, nausea, dysuria, renal dysfunction, vomiting, fatigue, and abdominal pain.

Additional Adverse Reactions Information

Selected clinically relevant adverse reactions in < 10% and ≥ 2% of patients who received Jelmyto include urinary tract inflammation, bladder spasm, urosepsis, hypersensitivity, and instillation site pain.

Use in Specific Populations
Lactation

Because of the potential for serious adverse reactions in a breastfed child, advise women not to breastfeed during treatment with Jelmyto and for 1 week following the last dose.

Preparation and Administration Information

Jelmyto is for pyelocalyceal use only and not for intravenous use, topical use, or oral administration. Jelmyto must be prepared and administered by a healthcare provider. To ensure proper dosing, it is important to follow the preparation instructions found in the JELMYTO Instructions for Pharmacy and administration instructions found in the JELMYTO Instructions for Administration.

Jelmyto may discolor urine to a violet to blue color following the instillation procedure. Advise patients to avoid contact with urine for at least six hours post-instillation, to void urine sitting on a toilet, and to flush the toilet several times after use.

Jelmyto is a cytotoxic drug. Follow applicable special handling and disposal procedures.

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.