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Cost of Camzyos on Medicare Drug Plan
Hypertrophic Cardiomyopathy (HCM) | Last Active: 5 days ago | Replies (25)Comment receiving replies
Please, tell me more: I have UHC Medicare Advantage PPO and after lots of calculations about Camzyos, the UHC customer rep said it would be about $500 to $800 "out of pocket". This means at least $6000 out of pocket for me, which I don't have because I'm helping other family members who are struggling financially due to unemployment, displacement from climate-crisis events in FL and CA etc.
Should I google Catastrophic Coverage or would that be a waste of time?
I guess I could afford about $100 a month ($1200 a year) but not much more. I read that it takes about 20 years for an FDA approved drug to go "generic". I won't be on the planet in 20 years! Also . . .
Does Walgreens actually provide prescribed Camzyos?
What if we "middle-classer-retirees" are just above the cut-off for the patient assistance program from Bristol Myers Squibb?
Replies to "Please, tell me more: I have UHC Medicare Advantage PPO and after lots of calculations about..."
Bristol Myers Squibb, the maker of Camzyos, has a Patients Assistance Foundation. If you qualify you can get Camzyos for free. https://www.bmspaf.org/
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This is my third year dealing with how to pay for Camzyos. Each year has been stressful. At the beginning, no one knew how to pay for it. I have had and still have all costs not covered by Medicare covered by a grant so I have no out of pocket expenses. My understanding is that under the Biden administration, a $2000 cap was put on Government Medicare (not an Advantage Medicare plan) for medication - at least the catastrophic category which is Camzyos. That is definitely the case for me this year. My pharmacy is Optum. You can only get Camzyos from certain pharmacies and they have to be part of the REMs program. My prescription is mailed to me every month. I would have had to pay a $1985 copay for the first month (January 2025). However, I found out that I still have a grant (I had no idea I had a grant) that not only covered this year's $1985 copay but will cover up to $10,000 of pharmacy costs. This grant has to be renewed each year. Since my copay is covered I will not have any more costs for Camzyos for 2025.
I can only offer advice based on how I am getting Camzyos covered but let me share this with you. First of all, my doctor's office was responsible for setting up my grant and Optum pharmacy also assisted me telling me how to initiate the grant for 2025. The grant is a Copay Assistance Card. My grant comes from the HealthWealth Foundation. My doctor's office initially did the paperwork to set it up. The only thing I had to do this year was contact the Foundation to get the grant Pharmacy card information and provide it to Optum.
If I were in your position I would talk to my doctor's office and ask for them to help you find a way to cover your costs. My doctor's office also set up my pharmacy (Optum) and they were told by BMS which pharmacies they could contact. You need to get help for all this. There was no way I would have known what questions to ask to get financial assistance or how to find the right pharmacies. I hope this is helpful and that I wasn't confusing. It is a confusing process.