Local, Dedicated Support
An Access and Reimbursement Manager (ARM) team, along with dedicated Nurse Navigatorsf are available for patients every step of the way
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)
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.
MEETING WITH A NURSE NAVIGATORf
The nurse navigator will help them navigate insurance benefits and sign up for the $0 co-pay offer.d
PRE-INITIATION TESTING
Before taking ZEPOSIA, patients will need bloodwork and an
electrocardiogram (ECG). Some patients may also require an eye exam.g
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