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Support From the Start: A Range of Resources for Patients Every Step of the Way

Support From the Start:
A Range of Resources for Patients Every Step of the Way

Once CAMZYOS® has been prescribed, MyCAMZYOS can assist with:

Patient Access Support*

  • Benefit reviews and
    reverifications
  • Prior authorizations (PA) and appeals support
  • Coordination with specialty pharmacies

Free Trial Program

  • One time, 35-day free trial for
    first-time patients

Bridge Program

  • Eligible commercially insured patients may access CAMZYOS at no cost if there is a delay or denial during the insurance coverage determination process

Co-Pay Assistance

  • Commercially
    insured patients may be eligible to pay as little as $10 for their CAMZYOS prescription

Echocardiogram Co-Pay Program

  • Commercially insured patients
    may be eligible for co-pay assistance for their required echocardiograms

Enroll your patients in MyCAMZYOS at account.covermymeds.com or by calling 855-CAMZYOS (855-226-9967)

*The 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.

Patient Access And Support Resources

MyCAMZYOS Enrollment (optional)

MyCAMZYOS Program Enrollment Form

Enroll your patient in the optional MyCAMZYOS patient support program via CoverMyMeds at account.covermymeds.com, by calling
855-CAMZYOS, or by faxing the form
to 833-302-1421

Access and Reimbursement

Additional resources to support patient access and coverage as needed.

Patient Authorization and Agreement Form

Patient consent for MyCAMZYOS enrollment

Letter of Medical Necessity Template

Establish the medical necessity of CAMZYOS

Letter of Medical Necessity Template (Echocardiogram)

Establish the medical necessity of the periodic echos required with
CAMZYOS treatment

Appeals Letter Template

Appeal a denied prior authorization request for CAMZYOS

Appeals Letter Template (Alternate Funding Program)

Appeal a denied claim for patients whose insurance plan may be participating in an alternate funding program

Formulary Exception Letter

Request a formulary exception to
allow coverage for CAMZYOS

Specialty Pharmacies

Contact details for specialty pharmacies

Specialty Pharmacy Contact Card

Download or print this resource for REMS-certified specialty pharmacies dispensing CAMZYOS

CAMZYOS can only be dispensed by pharmacies cerfified in the CAMZYOS REMS Program

Accredo
PHONE (877) 482-5927, Option 2
FAX (888) 302-1028
ERx NCPDP: 4436920
https://www.accredo.com/

CVS Specialty
PHONE (888) 626-1145
FAX (888) 626-7660
ERx NCPDP: 1466033
http://www.cvsspecialty.com/

Optum
PHONE (877) 576-1292
FAX (877) 342-4596
ERx NCPDP: 1564930
https://specialty.optumrx.com

Walgreens Specialty Pharmacy
PHONE (855) 244-2555
FAX (877) 231-8302
ERx NCPDP: 3974157
https://www.walgreensspecialtyrx.com

Rx Crossroads*
PHONE (855) 393-3619
FAX 724-754-0289
ERx NCPDP: 4541416

Alivia Health
PHONE (888) 925-1989
FAX (787) 925-1015
ERx NCPDP: 4030057
https://www.aliviahealth.com/special

*The dispensing Specialty Pharmacy for Free Trial Offer and Bridge is Rx Crossroads by McKesson.

Patient Education

REMS Brochure (required)

Prepare patients for treatment with CAMZYOS with information on the CAMZYOS REMS program

Patient Brochure

Prepare patients for treatment with CAMZYOS with information on obstructive HCM, CAMZYOS efficacy, safety, and more

Affordability Information for Patients

MyCAMZYOS Patient Support Program

Features important aspects of MyCAMZYOS such as access tools, tips, and resources to help patients with their treatment journey

CAMZYOS Co-Pay Program

Features steps for your eligible, commercially insured patients to apply for the CAMZYOS Co-Pay Program

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