CAMZYOS^® (mavacamten) Co-Pay Assistance Program

Terms and Conditions

The CAMZYOS Co-Pay Assistance Program is designed to assist eligible commercially insured patients who have been prescribed CAMZYOS with out-of-pocket deductibles, co-pays, or co-insurance insurance requirements.

Eligibility Requirements and Program Benefits

• Patients must have commercial (private) insurance, but their coverage does not cover the full cost of the prescription. Co-pay assistance is not valid where the entire cost of the prescription is reimbursed by insurance

• 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; patients who move from commercial to state or federal healthcare program insurance will no longer be eligible

• Cash-paying patients are not eligible for co-pay assistance

• Patients must be 18 years of age or older

• Patients must live in the United States or United States territories

• Eligible patients with an activated co-pay card and a valid prescription may pay as little as $10 per 30-day supply, subject to a maximum benefit of $15,000 per calendar year

Program Timing

• The enrollment period is for the first 2 years and then re-enrollment is required each calendar year thereafter

Additional Terms and Conditions

• 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 benefit received by the patient through this offer

• Acceptance of this offer confirms that this offer is consistent with patient’s insurance. Patients, pharmacists, and healthcare providers must report the receipt of co-pay assistance benefits if required by patient’s insurance provider

• All Program payments are for the benefit of the patient only

• Offer valid only in the United States and United States territories

• Void where prohibited by law, taxed, or restricted

• The Program is not insurance

• The Program benefits are not transferable and is limited to one (1) per patient. This offer cannot be combined with any other offer, rebate, coupon, or free trial

• This Program is not conditioned on any past, present, or future purchase, including additional doses

• No membership fees

• Bristol-Myers Squibb reserves the right to rescind, revoke, or amend this offer at any time without notice

Questions can also be submitted via mail to:
PO Box 2914
Phoenix, AZ 85062-2914.

By using this offer, you and your pharmacist understand and agree to comply with these Eligibility Requirements and Terms of Use.

CAMZYOS is available only through a restricted program called the CAMZYOS Risk Evaluation and Mitigation Strategy (REMS) Program.

Please see U.S. Full Prescribing Information, including Boxed WARNING and Medication Guide at CAMZYOS.com.