- Co-Pay Benefit Program Card (printable)
- Rebate Form (printable)
(For eligible patients, if your pharmacy [including mail order] is unable to provide instant savings, you can still receive a rebate by mail. Print the rebate form, follow the instructions, and mail it in.)
How the BMS Co-Pay Benefit Program works
Eligibility/Restrictions: Void where prohibited by law, taxed, or restricted. The card is not valid for prescriptions covered by Medicaid, Medicare, or federal or state programs (including state prescription drug programs, or private indemnity or HMO insurance plans, which reimburse you for the entire cost of prescription drugs). Card is limited to 1 per patient for the life of the program and is not transferable.
Bristol-Myers Squibb reserves the right to rescind, revoke, or amend this offer without notice. First use must take place by December 31, 2012. This offer expires December 31, 2013. For cardholder questions, call: 888-281-8981.
For eligible patients, Bristol-Myers Squibb will help pay for the cost of your prescription co-pay for
REYATAZ® (atazanavir sulfate) and/or SUSTIVA® (efavirenz) – up to the first $200 per co-pay per product for a maximum of 12 monthly co-pays within 1 year. If the total cost of your co-pay is over $200, you will be responsible for the outstanding balance. Please see chart below for details.
Examples of Savings per REYATAZ/SUSTIVA Co-Pay |
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- Your BMS Co-Pay Benefit Card is ready to use; no activation required*
- Show your card to your pharmacist every time you fill your prescription for REYATAZ or SUSTIVA
- You must use your card for the first time by 12/31/2012 and you can use your card for up to 12 monthly co-pays within 1 year
To Pharmacist: This program is for insured patients only. Submit primary claim to patient’s prescription drug insurance plan. Submit entire co-pay amount to Argus via the Co-pay Only Billing segment of NCPDP transaction. The card will pay up to the first $200 of a patient's monthly co-pay on each eligible claim. Patient will be responsible for paying any co-pay amount exceeding the first $200 on each eligible claim. The card is good for up to 12 monthly fills within 1 year of first use. This secondary assistance is for REYATAZ® (atazanavir sulfate) and SUSTIVA® (efavirenz) only. Argus Pharmacy Call Center Number: 888-850-2411.
First use must take place by December 31, 2012. This offer expires December 31, 2013.
REYATAZ and SUSTIVA are registered trademarks of Bristol-Myers Squibb.
