•Only valid for commerciallyinsured patients being treated with CAMZYOS
•If a coverage determination is delayed for twenty (20) calendar days or more, the patient will be provided CAMZYOS at no cost until coverage is received, a prior authorization is denied and not appealed, or for 18 dispenses, whichever is earlier
•An appeal of any prior authorization denial must be made within 60 days or as per payer guidelines to remain in the Program
•Patients continuing into the following year will be reverified for eligibility in January
•For patients whose insurance changes during the course of program participation and otherwise remain eligible, a new prior authorization must be submitted
•Program reserves the right to reverify patient’s insurance coverage at any point during the patient’s participation in the Program
•Offer is not conditioned on any past, present or future purchase, including refills
•Patients who have prescription insurance coverage through Medicare, Medicaid, or any other federal or state healthcare program are not eligible
•For more information patients must call 8552269967, Monday to Friday, 8 AM to 11 PM ET