| Description | NDC | Price for 30-day Supply *1 bottle/carton/pkg |
Price for 60-day Supply *2 bottles/cartons/pkgs |
Price for 90-day Supply *3 bottles/cartons/pkgs |
|---|---|---|---|---|
| Oral Solution: 0.05 mg/mL (210mL bottle) |
00003-1614-12 | $563 | $1,126 | $1,689 |
| Tablet: 0.5 mg (30 tablets/1 bottle) |
00003-1611-12 | $193 | $386 | $579 |
| Tablet: 1 mg (30 tablets/1 bottle) |
00003-1612-12 | $194 | $388 | $582 |
Terms and Conditions
BMS Patient Connect Direct-to-Patient Program (“Program”)
Select your medicine to review pricing:
*Days' Supply may vary based on prescribed dosing.
Eligibility and Restrictions
In order to participate in the BMS Patient Connect Direct-to-Patient Program (“Program”), a patient or caregiver must:
- Be 18 years of age or older
- Have a valid prescription for a BMS medicine for an FDA-approved indication
- Be a resident of the United States, Puerto Rico, or other select U.S. Territory
- Be uninsured, have insurance that does not cover the products listed, or have higher out-of-pocket expenses for the listed products through their insurance than under the Program or prefer to pay out of pocket instead of using insurance
If the patient has insurance and fulfills their prescription through this Program, the transaction will process outside of any insurance. Patient payments will not count toward any deductibles and cannot be applied to a patient’s maximum out-of-pocket costs. Patients and prescribers cannot seek reimbursement, from health insurance or any third party, for any medication received by the patient through this Program.
For patients enrolled in a Medicare Part D plan, a Medicare Advantage prescription drug plan, or any other federal or state healthcare program (collectively, “government insurance”), patients must also agree to:
- not seek reimbursement from their insurer for their out-of-pocket costs;
- not count the cost of their prescription toward their deductible or true out-of-pocket cost;
- purchase all prescriptions for their BMS medicine during the calendar year using the BMS Patient Connect Program and not seek coverage for the medicine from any federal or state government healthcare program at any time during this calendar year, even if their benefits change; and
- notify their government insurance program that their BMS medicine has been purchased outside of their prescription plan by sending the Bristol Myers Squibb provided Health Plan Notification letter
Bristol Myers Squibb reserves the right to rescind, revoke, or amend this Program and the cash price for BMS medicines under this Program at any time without notice. This Program's terms may change from time to time, and for the most recent version, please visit this webpage.
Reconfirmation of patient information may be requested periodically to ensure accuracy of data and compliance with terms. Patients with questions about the Program may call 1-866-526-7107.
This Program is not insurance. This Program is not conditioned on any past, present, or future purchase, including refills of any BMS medicine. This Program cannot be combined with any other coupon, free trial, discount, prescription savings card, or other Program not associated with this Program. This Program is valid only in the United States and its territories, unless prohibited by law. There are no membership fees.
By using this program, you certify that you meet the eligibility criteria and will comply with the terms and conditions described herein and will not seek reimbursement for any medication received through this Program.
Program Details
BMS Patient Connect utilizes a cash-pay pharmacy, and insurance is not accepted.
Patients enrolled in the Program can pay for their BMS medicines at the prices listed within these terms. Patien is responsible for applicable taxes, if any. Patients must provide payment prior to dispense and shipment of their prescription.
Disclosure of Third-Party Service Providers
CoverMyMeds (CMM) and BMS Patient Connect Pharmacy: BMS Patient Connect dispensing pharmacy responsible for patient accounts, payment collection, medication fulfillment, tracking, and shipping.
By using this service, you consent to have your prescription(s) processed and dispensed by a CMM Patient Direct-affiliated pharmacy. You understand that this may involve the transfer of your prescription within the CoverMyMeds Pharmacy network for the purpose of fulfilling your prescription.