The following downloads, links, and forms can help you and your practice navigate the treatment course with Jelmyto.
A brochure outlining the 4 simple steps to getting started with Jelmyto.
A brochure outlining financial support programs that are available for eligible patients who have been prescribed Jelmyto.
A comprehensive resource to ensure proper billing, coding and reimbursement of Jelmyto.
See preparation and instillation quantities for Jelmyto and learn what is required for accurate billing and sufficient reimbursement.
Information about Jelmyto including NDC, WAC, support, and distributor information.
A comprehensive resource on returned goods including eligible returns, credit and reimbursement, and return procedure.
Enroll patients in the UroGen SupportTM program.
Affirm your account or set up a new account with Cardinal Health SPD or Cencora-Besse Specialty Distributor.
For Veterans Affairs (VA) patients. Affirm your account or set up a new account with Cardinal Health SPD or Cencora-Besse Specialty Distributor.
Provides information that is generally used to determine medical necessity by payer.
Customizable letter supporting Jelmyto use in appropriate patients.
Communication starter kit to help educate staff and surrounding practices on Jelmyto.
Step-by-step guide for administering Jelmyto via ureteral catheter.
Step-by-step guide for preparing Jelmyto.
Request for nephrostomy tube placement with kidney volume measurement.
Jelmyto® (mitomycin) for pyelocalyceal solution is indicated for the treatment of adult patients with low-grade Upper Tract Urothelial Cancer (LG-UTUC).
Jelmyto is contraindicated in patients with perforation of the bladder or upper urinary tract.
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.
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.
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.
The most common adverse reactions in ≥ 20% of patients treated with Jelmyto were ureteric obstruction, flank pain, urinary tract infection, hematuria, abdominal pain, fatigue, renal dysfunction, nausea, dysuria, and vomiting.
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.
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.
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 hazardous drug. Follow applicable special handling and disposal procedures.
Please click here for Full Prescribing Information, Instructions for Pharmacy, and Instructions for Administration.