MyCAMZYOS Patient Support Access and Support Resources
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) Fax: 833-302-1421
| * | 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 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 |
| MyCAMZYOS Program Enrollment Form (Spanish) Spanish language version |
| Patient Authorization and Agreement Form Patient consent for MyCAMZYOS enrollment |
| Patient Authorization and Agreement Form (Spanish) Spanish language version |
| * | All patients prescribed CAMZYOS must be enrolled in the CAMZYOS REMS program. To do so, complete and submit the required REMS Patient Enrollment form. Please note the CAMZYOS REMS program is a separate program from the MyCAMZYOS Patient Support program. |
| Echocardiogram Co-Pay Assistance Program Guide Submit a reimbursement claim on behalf of your patient for an out-of-pocket echocardiogram |
| 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 Pharmacy Contact Card Download or print this resource for REMS-certified specialty pharmacies dispensing CAMZYOS |
CAMZYOS can only be dispensed by pharmacies certified in the CAMZYOS REMS Program
Accredo
PHONE: (877) 482-5927, Option 2
FAX: (888) 302-1028
ERx NCPDP: 4436920
ADDRESS: 1620 Century Center Parkway,
Memphis, TN 38134
https://www.accredo.com/
CVS Specialty
PHONE: (888) 626-1145
FAX: (888) 626-7660
ERx NCPDP: 1466033
ADDRESS: 800 Biermann Ct.
Mount Prospect, IL 60056
http://www.cvsspecialty.com/
Optum
PHONE: (877) 576-1292
FAX: (877) 342-4596
ERx NCPDP: 1564930
ADDRESS: 1050 Patrol Road
Jeffersonville, IN 47130
https://specialty.optumrx.com
Walgreens Specialty Pharmacy
PHONE: (855) 244-2555
FAX: (877) 231-8302
ERx NCPDP: 3974157
ADDRESS: 130 Enterprise Dr.
Pittsburgh, PA 15275
https://www.walgreensspecialtyrx.com
CenterWell Specialty Pharmacy
PHONE: (844) 387-5201
FAX: 800-504-7280
ERx NCPDP: 3677955
ADDRESS: 9843 Windisch Road
West Chester, OH 45069
CenterWellSpecialtyPharmacy.com
Alivia Health
PHONE: (888) 925-1989
FAX: (787) 925-1015
ERx NCPDP: 4030057
https://www.aliviahealth.com/specialty-pharmacy
CoverMyMeds*
PHONE: (855) 393-3619
FAX: 724-754-0289
ERx NCPDP: 4541416
| * | The dispensing Specialty Pharmacy for Free Trial Offer and Bridge is CoverMyMeds Pharmacy. |
| Bristol Myers Squibb does not endorse any specific pharmacy. Other eligible institutions may be able to dispense CAMZYOS. You may wish to consult your patient's individual plan requirements prior to prescribing for any direction regarding preferred dispensing pharmacies. |
| REMS Brochure 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 |
| 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 |