Supporting your patients every step
of the way

Eligible patients enrolled in ZEPOSIA 360 Support, who have been cleared to begin treatment, and who have not received a sample from their provider, will be provided a starter kit that includes a 7-day starter pack and a 30-day supply of ZEPOSIA.
ZEPOSIA® Starter Pack ZEPOSIA® Starter Pack
ZEPOSIA® Starter Pack
Get your patients started on ZEPOSIA
PATIENT
START FORM
Enroll your patients in ZEPOSIA 360 Support
and help them get started on treatment.

BMS Esign enables your patients to electronically sign through www.BMSesign.com

GETTING STARTED VIDEO

Helpful instructions to guide you
through the
process of getting your
patients started on ZEPOSIA.

Get the resources you and your patients need

From helpful tools and support to get them started on ZEPOSIA to additional help for your office.

ZEPOSIA 360 Support Program - Services for Patients
Eligible patients enrolled in ZEPOSIA 360 Support, who have been cleared to begin treatment, and who have not received a sample from their provider, will be provided a starter kit that includes a 7-day starter pack and
a 30-day supply of ZEPOSIA.
ZEPOSIA 360 Support™ Starter Kit Image
STARTER KIT
Free ZEPOSIA Starter Kit for Eligible Patientsa—which includes a 7-day starter pack along with an initial maintenance supply
ZEPOSIA 360 Support™Access Support Image
ACCESS SUPPORT
  • Electronic start form and prior authorization submissions available through Covermymeds Logo b
  • Access assistance—help with benefits investigation, prior authorization (PA), and appeals
ZEPOSIA 360 Support™ Pre-Initiation Support Image
PRE-INITIATION SUPPORT
Assistance with baseline assessments—including in-home services with scheduling and appointments available 7 days a week nationwide for eligible, commercially insured patientsc,d
Local, Dedicated Support
An Access and Reimbursement Manager (ARM) team, along with dedicated Nurse Navigatorsf are available for patients every step of the way
ZEPOSIA® Medication bottle
24-month bridge programe
A free supply of ZEPOSIA for up to 24 months to eligible, commercially insured patients if there is a delay or denial in coverage
For assistance, call 1-833-ZEPOSIA (833-937-6742)
Check List Image
Co-pay assistance programd
Helps patients with co-pay costs, including prescription and medical benefits where eligible patients pay as little as $0 for their prescription and can be fully reimbursed for out-of-pocket costs associated with pre-initiation testing
For financial assistance and support, call 1-833-ZEPOSIA (833-937-6742).
Fax: 833-727-7701. Monday thru Friday 8 AM until 8 PM ET. Or visit us online at: ZEPOSIAportal.com
Once you have prescribed ZEPOSIA for your patients, you will submit a Start Form to enroll
them in the ZEPOSIA 360 Support™ program. The support program will answer your patients’ questions and get them started on ZEPOSIA in
3 steps.
1.Meeting with a Nurse Navigator
MEETING WITH A NURSE NAVIGATORf
The nurse navigator will help them navigate insurance benefits and sign up for the $0 co-pay offer.d
2. Routine Testing
PRE-INITIATION TESTING
Before taking ZEPOSIA, patients will need bloodwork and an
electrocardiogram (ECG). Some patients may also require an eye exam.g
3. ZEPOSIA Delivery and Treatment
ZEPOSIA DELIVERY AND TREATMENT
Once patients are approved to start ZEPOSIA, the specialty pharmacy will call to schedule delivery of the ZEPOSIA starter kit. This kit includes a titrated 7-day Starter Pack and a 30-day supply of ZEPOSIA at the regular dosage.
aZEPOSIA Free Trial Offer: Patient must have a valid prescription for ZEPOSIA for an FDA-approved indication. Patient must be new to therapy and have not previously received a sample or filled a prescription for ZEPOSIA. Patient is responsible for applicable taxes, if any. This offer is limited to one use per patient per lifetime and is nontransferable. Cannot be combined with any other rebate/coupon, free trial, or similar offer. No substitutions permitted. Patients, pharmacists, and prescribers cannot seek reimbursement for the ZEPOSIA Free Trial from health insurance or any third party, including state or federally funded programs. Patients may not count the ZEPOSIA Free Trial as an expense incurred for purposes of determining out-of-pocket costs for any plan, including Medicare Part D true out-of-pocket costs (TrOOP). Offer is not conditioned on any past, present, or future purchase, including refills. Only valid in the United States and US Territories. Void where prohibited by law or restricted. The program is not insurance. Bristol Myers Squibb reserves the right to rescind, revoke, or amend this offer at any time without notice.
bThe accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.
cZEPOSIA In-Home Medical Services Program: Patient must have a valid prescription for ZEPOSIA for an FDA-approved indication. Patient must be commercially insured. Patients are not eligible if they have prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare, Medicaid, Medigap, CHAMPUS, TRICARE, Veterans Affairs (VA), or Department of Defense (DoD) programs, or reside in Rhode Island. To receive the In-Home Medical Services Program, the prescriber must request in-home assessment assistance through the ZEPOSIA 360 Support program. The patient’s insurance will not be billed, and the patient will not be responsible for any out-of-pocket costs. Patients who move from commercial plans to state or federal healthcare programs will no longer be eligible. The program cannot be combined with any other offer, rebate, coupon, or free trial. The program is not conditioned on any past, present, or future purchase, including refills. Only valid in the United States and US Territories. Void where prohibited by law, taxed, or restricted. The program is not insurance. Bristol-Myers Squibb Company reserves the right to rescind, revoke, or amend this program at any time without notice. Other limitations may apply.
dCombined Co-Pay Programs (Drug and Medical Benefit): ZEPOSIA Co-Pay Program is valid only for patients with commercial (private) insurance. The Program includes a prescription benefit offer for out-of-pocket drug costs and a medical assessment benefit offer for out-of-pocket costs for the initial blood tests and ECG screening where the full cost is not covered by patient’s insurance. Patients are not eligible for the prescription benefit offer if they have prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare, Medicaid, Medigap, CHAMPUS, TRICARE, Veterans Affairs (VA), or Department of Defense (DoD) programs. Patients are not eligible for the medical assessment benefit offer if they have insurance coverage for their prescription or medical assessment through a state or federal healthcare program, or reside in Massachusetts, Minnesota, or Rhode Island. Patients who move from commercial plans to state or federal healthcare programs will no longer be eligible. Patient must be 18 years of age or older. Patients pay as little as $0 in out-of-pocket costs per prescription, subject to a maximum benefit of $18,000 during a calendar year. Patients pay as little as $0 in out-of-pocket costs for the medical assessment, subject to a maximum benefit of $2,000. The medical benefit offer only applies to clinical baseline assessment services covered by the Program. Patients are responsible for any costs that exceed the maximum amounts. To receive the medical assessment benefit, an Explanation of Benefits (EOB) form must be submitted, along with copies of receipts for any payments made. The Program expires on December 31, 2023. All Program payments are for the benefit of the patient only. Patients, pharmacists, and prescribers may not seek reimbursement from health insurance, health savings or flexible spending accounts, or any third party, for any part of the prescription or medical assessment benefit received by the patient through this Program. Patient’s acceptance of any Program benefit confirms that it is consistent with patient’s insurance and that patient will report the value received as may be required by his/her insurance provider. Program valid only in the United States and Puerto Rico. Void where prohibited by law, taxed, or restricted. The Program cannot be combined with any other offer, rebate, coupon, or free trial. The Program is not conditioned on any past, present or future purchase, including refills. The Program is not insurance. Other limitations may apply. Bristol Myers Squibb reserves the right to rescind, revoke, or amend this Program at any time without notice.
eBridge Program: The Bridge Program is available at no cost for eligible, commercially insured, on-label diagnosed patients if there is a delay in determining whether commercial prescription coverage is available, and is not contingent on any purchase requirement, for up to 24 months (dispensed in 30-day increments). The Bridge Program is not available to patients who have prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare, Medicaid, Medigap, CHAMPUS, TRICARE, Veterans Affairs (VA), or Department of Defense (DoD) programs and is available for no more than 12 months to patients in MA, MN, and RI. Appeal of any prior authorization denial must be made within 90 days or as per payer guidelines to remain in the program. Eligibility will be re-verified in January for patients continuing into the following year, and may be at other times during program participation. Offer is not health insurance. Once coverage is approved by the patient’s commercial insurance plan, the patient will no longer be eligible. Void where prohibited by law, taxed, or restricted. Bristol-Myers Squibb Company reserves the right to rescind, revoke, or amend this program at any time without notice. Other limitations may apply.
fNurse Navigators can answer questions about ZEPOSIA, but they cannot provide medical advice.
gDiabetes mellitus and uveitis increase the risk of macular edema; patients with a history of these conditions should have an ophthalmic evaluation of the fundus, including the macula, prior to treatment initiation. A prompt ophthalmic evaluation is recommended if there is any change in vision while taking ZEPOSIA.1
Nationwide, {>90%} of patients with commercial coverage have access to ZEPOSIAh
Find ZEPOSIA Coverage in Your Area
Step 1: Find ZEPOSIA coverage by location
In your area, {} of patients with commercial coverage have access to ZEPOSIA
Step 2: Filter results by health plan/pharmacy benefit manager (PBM) type



Find ZEPOSIA coverage by health plan/PBM
hBased on Weekly Field Intelligence Input and MMIT, as of August 2022.
For most payers, prior authorization requirements include confirmation of diagnosis, prescribed by a specialist, and previous failure of generic therapies. However, different or additional criteria may apply. Please contact ZEPOSIA 360 SupportTM for assistance
Downloadable Resources
GETTING STARTED VIDEO
Helpful instructions to guide you through
the process
of getting your patients started
on ZEPOSIA.
Getting Patients StartedGetting Patients Started
Start Form
Enrolls patients in ZEPOSIA 360 Support and helps them get started on treatment. Download the start form or get started online.
BMS eSign
Available for your patients who forget to sign the ZEPOSIA Start Form. BMS eSign enables your patients to sign electronically.
Initiation and Support Brochure
Provides important information on how to get patients started on ZEPOSIA and an overview of key benefits available through the ZEPOSIA 360 Support program.
Tyramine and ZEPOSIA Food and Drug Interaction Information
A helpful list of food and beverages that are high in tyramine (150 mg or more)—a compound that should be avoided at high levels if your patients are taking ZEPOSIA.
Patient Decision Kit
Provides a comprehensive look at ZEPOSIA for patients and outlines steps to get them started on therapy.
Patient Brochure
Provides a streamlined version of the Patient Decision Kit, including a quick overview of ZEPOSIA and ZEPOSIA 360 Support.
Access & Support
Access Resources for Healthcare Providers
Brochure highlights tools for healthcare providers to assist in getting appropriate patients access to ZEPOSIA.
Authorization and Appeals Kit
Offers information on potential coverage scenarios for ZEPOSIA, and outlines services offered by ZEPOSIA 360 Support.
Formulary Exception Letter
Helps you advocate for your patients, so
they can gain approval to start therapy
with ZEPOSIA.
Letter for Medical Necessity for Patients Currently Receiving MS Treatment
Enables you to help your patients continue receiving therapy.
Letter for Medical Necessity for Patients Not Currently Receiving MS Treatment
Helps your patients not currently receiving any therapy to get started on ZEPOSIA.
Letter of Appeal for Patients Currently Receiving MS Treatment
Enables you to advocate for patients who are currently receiving therapy, if they receive an unfavorable coverage decision.
Letter of Appeal for Patients Not Currently Receiving MS Treatment
Enables you to advocate for patients who are not currently receiving therapy, if they receive an unfavorable coverage decision.
Additional Resources ImageAdditional Resources
Specialty Pharmacy Resource
Provides a quick overview of the benefits of using Specialty Pharmacies (SPs) and a list of SPs ready to handle ZEPOSIA prescriptions.
Baseline Testing Clearance Form
This form is used by the ZEPOSIA 360 Support clinical partners to verify that a patient’s baseline tests have been reviewed by their prescriber and that they are able to start therapy. This form needs to be submitted, either online or by fax. If not, someone from ZEPOSIA 360 Support will contact you for verbal confirmation of baseline test completion.
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