SOTYKTU Co-Pay Assistance Terms and Conditions

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 $0 per 30-day supply; monthly and annual maximum program benefits apply and may vary from patient to patient, depending on the terms of a patient’s prescription drug plan and based on factors determined solely by Bristol-Myers Squibb

PROGRAM TIMING

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

ADDITIONAL TERMS & 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

Bridge Program Terms and Conditions

Eligibility Requirements:

To be eligible for the SOTYKTU Bridge Program for SOTYKTU (deucravacitinib):

  • A SOTYKTU prescription for an FDA-approved use
  • Commercial insurance with coverage
  • Submitting a Prior Authorization (PA) within 90 days of SOTYKTU Bridge Program enrollment
  • Submitting an Appeal/Exception/Letter of Medical Necessity (LMN) to challenge PA payer outcome within 90 days or per payer guidelines of PA outcome if coverage is denied
  • Program requires a periodic check of your insurance coverage status to confirm your continued eligibility, including, but not limited to the annual reverification process. Program is available until your commercial insurance covers your medication for up to 36 months (dispensed in 30-day prescriptions). Up to 12 months coverage for residents in Massachusetts, Minnesota, and Rhode Island
  • A signed Patient Authorization and Agreement (PAA) is on file
  • US residents only
  • SOTYKTU Bridge Program is not available to patients who have prescription insurance coverage through Medicare, Medicaid, or any other federal or state program

BRIDGE TO COMMERCIAL COVERAGE OFFER:

The SOTYKTU Bridge Program is available at no cost for eligible, commercially insured, on-label diagnosed patients and whose prior authorization is denied or delayed, and is not contingent on any purchase requirement, for up to 36 months (dispensed in 30-day prescriptions). The prescriber has certified that therapy with SOTYKTU is medically necessary for this patient and will be supervising the patient’s treatment accordingly. The SOTYKTU Bridge Program is not available to patients who have prescription insurance coverage through Medicare, Medicaid, or any other federal or state program, and is available for no more than 12 months to patients in MA, MN, and RI. Appeal of any prior authorization denial must be made within 90 days or as per payer guidelines, to remain in the Program. Eligibility will be re-verified on a rolling 12-month basis from the patient’s first shipment date, and may be re-verified at other times during Program participation. Offer is not health insurance, and may be modified or discontinued at any time without notice. Once coverage is approved by the patient’s commercial insurance plan, the patient will no longer be eligible. Other limitations may apply. Bristol-Myers Squibb reserves the right to rescind, revoke, or amend the Program at any time without notice.

Free Trial Offer Terms and Conditions

Eligibility Requirements:

To be eligible for the SOTYKTU Free Trial Offer for SOTYKTU (deucravacitinib):

  • Patients must be new patients who have not previously received a sample or filled a prescription for SOTYKTU
  • Patients must have a valid 30-day prescription for SOTYKTU for an on-label indication
  • Patients are 18 years of age or older
  • Patients are residents of the United States or a US Territory

TERMS OF USE:

  • Eligible patients with a valid 30-day prescription for SOTYKTU can receive a free 30-day supply of SOTYKTU. Patient is responsible for applicable taxes, if any. This offer may not be redeemed on prescriptions written for longer than 30 days.
  • This offer is limited to one use per patient per lifetime and is non-transferable. By redeeming this offer, patients certify that you have not previously filled a prescription for SOTYKTU.
  • The SOTYKTU Free Trial Offer for the specified prescription cannot be combined with any other rebate/coupon, free trial or similar offer. No substitutions are permitted.
  • Patients, pharmacists, and prescribers cannot seek reimbursement for the SOTYKTU Free Trial Offer of SOTYKTU from health insurance or any third party, including state or federally funded programs.
  • Patients may not count the SOTYKTU Free Trial Offer of SOTYKTU as an expense incurred for purposes of determining out-of-pocket costs for any plan, including true out-of-pocket costs (TrOOP), for purposes of calculating the out-of-pocket threshold for Medicare Part D plans.
  • Only valid in the United States and US Territories; this offer is void where restricted or prohibited by law.
  • Bristol Myers Squibb reserves the right to rescind, revoke, or amend this offer at any time without notice.
  • This offer is not conditioned on any past, present, or future purchase, including refills.
  • The SOTYKTU Free Trial Offer is not health insurance.

BY REDEEMING THIS OFFER, PATIENT AND PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

1787-US-2200571 09/22
SOTYKTU, SOTYKTU 360 SUPPORT, and SOTYKTU logo are trademarks of Bristol-Myers Squibb Company.
All other trademarks are property of their respective owners.
© 2022 Bristol-Myers Squibb Company.
1787-US-2200141 09/22
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