CAMZYOS™ (mavacamten) Co-Pay Assistance Program Terms & 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 or their guardian 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 $10 per 30-day supply, subject to a maximum benefit of $15,000 per calendar year

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

CV-US-2200113 03/22

CAMZYOS™ (mavacamten) Bridge Program Terms & Conditions

• This offer is available to commercially-insured patients being treated with CAMZYOS for an on-label indication
• Patients who have prescription insurance coverage through Medicare, Medicaid, or any other federal or state healthcare program are not eligible.
• If a coverage determination is delayed for more than 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 one (1) year, 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 re-verified 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 re-verify patient’s insurance coverage at any point during the patient’s participation in the Program
• No claim for reimbursement for product dispensed pursuant to this offer may be made to any third-party payer
• This offer is not conditioned on any past, present, or future purchase, including refills
• Valid only in the United States and United States territories
• This offer is not health insurance
• Other restrictions may apply
• Bristol-Myers Squibb reserves the right to modify or discontinue this offer at any time without notice

CV-US-2200467 09/22

CAMZYOS™ (mavacamten) Free 35-Day Trial Offer Program Terms & Conditions

Eligibility Requirements:

To be eligible for the Free 35-Day Trial Offer for CAMZYOS:

• Patients must not have previously filled a prescription for CAMZYOS
• Patient must have a valid 35-day prescription for CAMZYOS 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 35-day prescription for CAMZYOS can receive a free 35-day supply of CAMZYOS. Patient is responsible for applicable taxes, if any. This offer may not be redeemed on prescriptions written for longer than 35 days
• This offer is limited to one use per patient per lifetime and is non-transferrable. By redeeming this offer, the patient certifies that they have not previously filled a prescription for CAMZYOS
• The Free 35-Day Trial 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 Free 35-Day Trial of CAMZYOS from health insurance or any third party, including state or federally funded programs.
• Patients may not count the Free 35-Day Trial of CAMZYOS 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 CAMZYOS Free 35-Day Trial offer is not health insurance

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

CV-US-2200197 04/22

CAMZYOS™ (mavacamten) Echocardiogram Co-Pay Assistance Program Terms & Conditions

Eligibility Requirements

• This offer is available to commercially-insured patients being treated with CAMZYOS for an on-label indication
• Patients must have commercial (private) insurance. The Program includes medical benefit offer for out-of-pocket costs for required echocardiogram assessments where the full cost is not covered by the patient’s insurance
• Patients are not eligible if they have medical 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, or are residents of Massachusetts, Minnesota, or Rhode Island. Patients who move from commercial plans to state or federal healthcare programs will no longer be eligible
• Patients must be 18 years of age or older
• Patients must live in the United States or United States territories

Program Benefits

• Patients pay as little as $0 in out-of-pocket costs per echocardiogram assessment, subject to an annual maximum benefit of $2,500. Patients are responsible for any costs that exceed the maximum amounts
• To receive the Program benefits, claims must be submitted within 180 days of the date of service
• The program may apply retroactively out of pocket expenses that occurred within 180 days prior to the date of enrollment
• All Program payments are for the benefit of the patient only

Program Timing

• The enrollment period is for 1 calendar year

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 as may be required by patient’s insurance provider
• This offer is not valid with any other program, discount, or incentive involving a BMS medication eligible for this Program
• 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
• This Program is not conditioned on any past, present, or future purchase
• No membership fees
• Bristol-Myers Squibb reserves the right to rescind, revoke, or amend this offer at any time without notice

CV-US-2200195 04/22