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Bulletin Bristol-Myers Squibb Co-Pay Benefit Program Communication # 85BR09 BIN: 600428 PCN: 05080000 GRP: 05380001 Date: December 22, 2009 Effective Date: January 1, 2010 Summary Bristol Myers Squibb is extending the Copay Benefit Program through December 31, 2010. No action is required on your part, the program change will be managed by Argus. What You Need to Know On January 1, 2010 the Bristol-Myers Squibb Co-pay Benefit Program will be revising program parameters to further assist HIV (human immunodeficiency virus) patients with their out of pocket costs for Reyataz® (atazanavir) and Sustiva® (efavirenz) medications. The patient will be responsible for only the portion of the claim that exceeds $200 for a monthly prescription. Program Parameters Patient Eligibility: •
No activation or enrollment is required.
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This program is intended for patients with prescription insurance only.
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This program is not valid for patients participating in Medicaid, Medicare (including Medicare Part D), or other state or federal programs.
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This program is not valid for residents of Massachusetts.
Program Benefits: •
A valid prescription must be presented at the pharmacy.
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Bristol-Myers Squibb will provide copay assistance up to the first $200.00 of the prescription copay for a monthly supply.
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The patient’s out of pocket cost will be the remaining amount of the copay (that exceeds the initial $200.00) for a monthly supply.
©2009 by Argus Health Systems, Inc. All Rights Reserved. The computer systems, procedures, databases, software programs, documentation and other materials (collectively "Information") created, maintained or provided by Argus Health Systems, Inc. ("Argus"), are proprietary to Argus and are confidential. 85BR09
Argus Health Systems, Inc. 1300 Washington St. Kansas City, MO 64105-1433 www.argushealth.com
All of the information on this page constitutes a trade secret, privileged or confidential information, as such terms are interpreted under the Freedom of Information Act and applicable case law.
Eligible Drugs: Reyataz: •
100MG: 00003-3623-12
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150MG: 00003-3624-12, 35356-0068-06, 35356-0068-60, 54569-5530-00, 54868-4857-00, 67263-0230-60, 68258-9142-01
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200MG: 00003-3631-12, 35356-0207-60, 54569-5532-00, 54868-4854-00
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300MG: 00003-3622-12, 35356-0114-06, 35356-0014-30, 54868-5838-00
Sustiva: •
50MG: 00056-0470-30
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100MG: 00056-0473-30
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200MG: 00056-0474-92, 35356-0069-90, 54569-4611-00, 68258-902-101
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600MG: 00056-0510-30, 35356-0115-06, 35356-0115-30, 54569-5374-00, 54868-4668-00, 67263-0568-30, 68258-9020-01
Processing Claims Please use NCPDP version 5.1 and provide the following required information for each claim submitted: FIRST: Submit to patients’ primary insurance to receive copay response (valid for patients with insurance only) THEN: Submit COPAY ONLY transmission to Argus: •
BIN: 600428
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Rx PCN: 05080000
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Rx GRP: 05380001
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Member ID: XXXXXXXXX (Please Note: Do Not Include Suffix)
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Cardholder First and Last Name
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Date of Birth
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Patient First and Last Name
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Product information and quantity/days supply
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Patient’s Copay amount (received from primary insurance carrier)
Payer Sheets To view the payer sheets on www.argushealth.com: •
Click the MyArgus online link in the upper left-hand corner of the website.
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Enter the Username and Password.
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Click on the Pharmacy link.
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Select Global PCN 0508 under the Commercial/Generic drop-down box. All of the information on this page constitutes a trade secret, privileged or confidential information, as such terms are interpreted under the Freedom of Information Act and applicable case law.
Argus bulletin – 2009
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Card Samples
Bristol-Myers Squibb Co-Pay Benefit Program front of card
Bristol-Myers Squibb Co-Pay Benefit Program back of card Action Required For assistance processing claims, please contact the Argus Health Systems Help Desk at 1-888-850-2411, which is available 24 hours a day/7 days a week.
All of the information on this page constitutes a trade secret, privileged or confidential information, as such terms are interpreted under the Freedom of Information Act and applicable case law. Argus bulletin – 2009
page 3