BRISTOL-MYERS SQUIBB

Bristol Myers Squibb (BMS) is committed to helping appropriate patients get access to BMS medications by providing access and reimbursement support services.

For more information, search the prescribed BMS product in this Guide, go online, or call 1.800.861.0048, Monday through Friday, 8:00 AM to 8:00 PM EST.

Oncology-related products: Abraxane® (albumin-bound) for intravenous use, Abraxane® (paclitaxel protein-bound particles) for injectable suspension, Empliciti® (elotuzumab) for injection, Idhifa® (enasidenib) tablets, Inrebic® (fedratinib) capsules, Istodax® (romidepsin) for injection, Krazati® (adagrasib) tablets, Onureg® (azacitidine) tablets, Opdivo® (nivolumab) injection for intravenous use, Opdualag™ (nivolumab and relatimab-rmbw) injection for intravenous use, Pomalyst® (pomalidomide) capsules, Reblozyl® (luspatercept-aamt) for injection, Revlimid® (lenalidomide) capsules, Sprycel® (dasatinib) tablets, Thalomid® (thalidomide) capsules, Vidaza® (azacitidine for injection) for subcutaneous or intravenous use, Yervoy® (ipilimumab) injection for intravenous use

Co-Pay Card/Out-Of-Pocket Cost Assistance

BMS Access Support Oncology Co-Pay Assistance Program

This program is designed to assist eligible, commercially insured patients who have been prescribed select Bristol Myers Squibb (BMS) medications with out-of-pocket deductibles, co-pays, or co-insurance requirements.

To be eligible, patients must have commercial (private) insurance that covers the prescribed BMS medication but does not cover the full cost, and patients must live in the United States or Puerto Rico.

Patients may not be participating in any state or federal healthcare program, including Medicaid, Medicare, Medigap, CHAMPUS, TriCare, Veterans Affairs, or Department of Defense, or any state, patient, or pharmaceutical assistance program. Patients who move from commercial (private) insurance to a state or federal healthcare program will no longer be eligible. If patients have purchased their prescription insurance through a Health Exchange (also known as a Health Insurance Marketplace or Small Business Health Options Program [SHOP] Marketplace), they are currently eligible.

Program benefits and limits include:

• For patients prescribed Abraxane or Reblozyl, the program will cover the co-pay for each dose, up to a maximum of $10,000 per BMS medication during a calendar year.
• For patients prescribed Empliciti, Opdivo, Opdualag, Yervoy, or Opdivo plus Yervoy, they must pay the first $25 of the co-pay for each dose of a BMS medication. The program will cover the remainder of the co-pay, up to a maximum of $25,000 per BMS medication during a calendar year. (For clarification, if a patient is prescribed two BMS medications in combination, the maximum is $50,000.) Patients are responsible for any costs that exceed the $25,000 maximum.
• For patients prescribed Idhifa, Inrebic, Onureg, Pomalyst, Revlimid, or Thalomid, they may pay as little as $10 per one-month supply, subject to a maximum benefit of $15,000 per calendar year (excluding certain dispensing costs).
• For patients prescribed Sprycel, they may pay as little as $0 per 30-day supply, subject to a maximum benefit of $15,000 per calendar year (excluding certain dispensing costs).

Enroll patients online by selecting the prescribed medication on its website or fax the specific medication’s enrollment form to 1.800.822.2496. For more information, call the BMS support center at 1.800.861.0048, Monday through Friday, 8:00 AM to 8:00 PM EST.

Reimbursement Assistance

BMS Access Support®

Bristol Myers Squibb (BMS) is committed to helping appropriate patients get access to BMS medications by providing access and reimbursement support services.

Benefits Reviews

BMS can review patient coverage for their medication. Reviews are typically completed within a median time of 24 hours. For enrolled patients, benefits may also be reverified.

Prior Authorization Assistance

BMS Access Support is ready to assist by providing information about the prior authorization process. A BMS Access Support care coordinator can:

• Conduct a benefits review, obtaining information about any prior authorization requirement
• Call the payer to obtain prior authorization details
• Fax a summary of benefits to healthcare provider.

Appeals Assistance

If the patient's insurer has denied coverage, the denial may be appealed. BMS Access Support may be able to assist by providing information about the appeals process.

To start a benefits review, visit the program website and select the prescribed medication. For more information, call the BMS support center at 1.800.861.0048, Monday through Friday, 8:00 AM to 8:00 PM EST.

Independent Charitable Foundations/Organizations

BMS Access Support® Referrals

Bristol Myers Squibb (BMS) Access Support can help healthcare providers research independent charitable foundations that may be able to help underinsured and uninsured patients.

For more information, call BMS Access Support at 1.800.861.0048, Monday through Friday, 8:00 AM to 8:00 PM EST.

Bristol Myers Squibb Patient Assistance Foundation

The Bristol Myers Squibb Patient Assistance Foundation (BMSPAF) is an independent, charitable organization that helps eligible patients who need temporary help obtaining the medicines listed on its website.

Patients may be eligible for the BMSPAF if they:

• Live in the United States, Puerto Rico, or the U.S. Virgin Islands
• Are being treated by a U.S. licensed prescriber
• Are being treated with the medicine as an outpatient

1. Do not have insurance coverage for the prescribed medicine listed on the BMSPAF website.

• Are prescribed a BMS medicine for cancer (even if their income is higher than the limits listed online).

Other eligibility criteria may apply. For more information, call BMSPAF at 1.800.736.0003. Patients can also find out if they are eligible by completing a short assessment.