Dedicated Nurse Navigators provide a consistent point of contact for your patients taking ZEPOSIA
a free supply of ZEPOSIA for up to 24 months to qualified, commercially insured patients who are at risk of an interruption in therapyb
helps patients with co-pay costs, including prescription and medical assessment/initiation costsc
aFor patients with commercial coverage in all states except MA, MN, and RI.
bThe 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. The Bridge Program is not available to patients who have prescription insurance coverage through Medicare, Medicaid, or any other federal or state program, or MA or MI residents, and is available for no more than 6 months (180 days) to patients in 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. Up to 12 additional refills may be provided if needed. Offer is not health insurance, and may be modified or discontinued at any time without notice. Other limitations may apply.
cDepending on insurance coverage and where the full cost is not covered by patient’s insurance, eligible patients may receive a prescription benefit offer for out-of-pocket drug costs and pay as little as $0 per prescription, as well as a medical assessment benefit offer for out-of-pocket costs for the initial blood tests and ECG screening. Maximum savings limit applies; patient out-of-pocket expenses may vary. This program is not health insurance. Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state health care programs. Please visit ZEPOSIA.com/copayterms for Program Terms, Conditions, and Eligibility Criteria. Medical co-pay benefit not available for residents of MA, MI, MN, and RI.
ECG=electrocardiogram.
| ACCESS AS OF DECEMBER 2020 | |||
|---|---|---|---|
| Payer | Cigna | CVS | Express Scripts (ESI) |
| Formulary Status | Preferred | Covered | Covered |
| Restrictionsa | PA | PA | PA, ST |
| Step Requirements | None | None | Single Step |
Formulary data are provided periodically by MMIT and Data on File, Bristol Myers Squibb, and are current as of December 2020.
The information is updated periodically, and this page is not a guarantee of coverage by any of the payers listed. Insurers and their beneficiary payer can change without notice, and patients' coverage and conditions should be verified with applicable insurers.
aFor most payers, prior authorization requirements include confirmation of diagnosis and be prescribed by a neurologist. However, additional criteria or documentation may be required. Please contact ZEPOSIA 360 Support™ for assistance.
PA=prior authorization; ST=step therapy.
For additional assistance on access for your appropriate patients, please contact ZEPOSIA 360 Support™ at 1‑833‑ZEPOSIA (1‑833‑937‑6742)
AssistRx is a third-party service that simplifies patient access, provides resources, and accelerates time to therapy. Services are offered through a provider portal.
CoverMyMeds offers electronic Prior Authorization (ePA) support. A prescriber-facing ePA is available for locating, submitting, and tracking PAs and pre‑certifications.
ICD Code: For reimbursement purposes, the ICD-10-CM code for patients with a multiple sclerosis diagnosis is G35.
Available for your patients who forget to sign the ZEPOSIA Start Form. BMS eSign enables your patients to electronically sign through www.BMSesign.com
Provides important information on how to get patients started on ZEPOSIA and an overview of key benefits available through the ZEPOSIA 360 Support™
A helpful list of foods and beverages that are high in tyramine (150 mg or more)—a compound that should be avoided if your patients are taking ZEPOSIA
Helps to identify which of your patients are potentially eligible for ZEPOSIA
Provides a comprehensive look at ZEPOSIA for patients and outlines steps to get them started on therapy
Provides a streamlined version of the Patient Decision Kit including a quick overview of ZEPOSIA and ZEPOSIA 360 Support™
Provides a quick overview of the benefits of using specialty pharmacies (SPs) and a list of SPs ready to handle ZEPOSIA prescriptions
Provides an outline of how to enroll and manage patients using the ZEPOSIA Portal
Provides a brief overview of in-home services available to patients in partnership with Signify Health
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
Provides an overview of iAssist, an online resource that seamlessly onboards providers and patients through the start of therapy and offers a range of services
Offers information on potential coverage scenarios for ZEPOSIA, explains how to navigate authorizations and appeals (including template letters), and outlines services offered by ZEPOSIA 360 Support™
Enables you to help patients continue receiving therapy
Helps your patients not currently receiving any therapy get started on ZEPOSIA
Enables you to advocate for patients who are currently receiving therapy, if they receive an unfavorable coverage decision
Enables you to advocate for patients who are not currently receiving therapy, if they receive an unfavorable coverage decision
Helps you advocate for your patients, so they can gain approval to start therapy with ZEPOSIA
Brochure highlighting tools for healthcare providers to assist in getting appropriate patients access to ZEPOSIA
This information is intended for U.S. Healthcare Professionals.