Cost of Camzyos on Medicare Drug Plan

You are correct Camzyos is a “non-covered” drug so it does have to be "authorized" based on a justification from your doctor. My authorization was for one year. I was already in the "donut hole". So, my monthly cost were estimated to be around the $1900 you mentioned. I am not sure how the 2025 out of pocket drug cap of $2,000 will work.

But, thank God I get patience assistance from Bristol Myers. The income limit is higher than you might think.

Thank you. I will look into the patience assistance program.

Hello @jaymaysea and @otterbesewing,
I hope this message finds you well. I am a Medicare insurance agent out of FL, and I'm working to assist a client with their Medicare Drug plan for 2025. Unfortunately, he received a letter from his current Part D plan indicating that a particular medication is no longer covered. Furthermore, I've discovered that it is not covered under any Part D plan either!
Have you found any workarounds to help this individual get access in 2025 to Camzyos at a reasonable cost? Any assistance would be greatly appreciated. Thank you!

I would never be on Camzyos without the patient assistant program through the drug company. This is all handled by my Cardiologist office. It is a hassle, but well worth it.

Are you on Medicare or traditional insurance? I am 66 and still working and get Camzyos thru BMS patient assistance. However, I have not converted to Medicare yet as I have not figured out how to get Camzyos with Medicare (and I’m a pharmacist working at a university hospital). Very frustrating.

My recommendation is to get Medicare plus a supplement. None of the advantage plans apparently cover Camzyos in 2025 and it is impossible to go back to traditional Medicare from advantage when you have HCM because it has been go through underwriting (at least in Florida). Save yourself that challenge!

Hi -I am new here. Can you tell me more about how much Bristol Myers patient assistance programs helps financially and about how the income qualification aspect works generally speaking - meaning income ranges and coverage potential. It is open season and I just cannot get enough information from my supplemental insurance plan about what they will cover on different plans. I understand that Medicare does not cover Camzyos in either traditional or plan Ds. I am in a bit of a panic here ( I am seeing the Hopkins cardiac REMS next week and I'd like to know what to expect and ask). The doctor I am seeing (his medical coordinator) has not called me back re: what to know beforehand. Do any of you know an average that people are paying once a supplemental plan does authorize the drug. Are they all vastly different? Or is there an average range. Not knowing any of the above is unnerving to say the least. But, I know, one step at a time...deep breath.

I too am in a panic having having gotten nowhere trying to figure out how to reduce the cost of Camzyos on my own. I'm now working with a broker, but there are still hurdles.
1) otterbesewing @otterbesewing : I’m working with an insurance broker and he said NONE of the insurers in my area (Northern CA) include Camzyos on their formulary. Would you please let people know what health plan you’re on? Knowing a health plan that is willing to include it in their formulary would shorten dramatically the process of asking all insurers in my area if they would add it. Thank you!
2) @andrewbradlyn : None of the medicare supplement plans offered in my area will cover Camzyos (without perhaps a doctor's request). From what I gather, it's the same for all the people above, except for otterbesewing who was able to have Camzyos added to his/her insurer's formulary.

My traditional Part D Medicare Rx covered 100% of my camzyos for 2024. My Part D is through UHC and I had to change pharmacies to Walgreens. On the back of my EOB summary highlighted under the Drug Payment stages states I am in the "Catastrophic Coverage : In this stage, the plan pays all the cost for your covered Part D drugs."

When I first started on Camzyos (1.5 years ago), My doctors office had to fill out a form to Medicare stating that there was no other drug available for my condition. Fortunately my cardiologist and the cardiology department is experienced with the Camzyos patient and the craziness we have to go through to get covered.

Hopkins should be experienced with this process at this point. I found this for you - it is the form Hopkins has for applying for Camzyos
https://www.hopkinsmedicine.org/-/media/johns-hopkins-health-plans/documents/usfhp/usfhp_camzyos_pa_form.pdf