Terms and Conditions for the ORENCIA® (abatacept)
Co-pay Assistance for Subcutaneous and Intravenous Use

  • Patients must have commercial insurance that pays for ORENCIA but does not cover the full cost. Co-pay assistance is not available if patient out-of-pocket expenses are $5 or less.
  • Patients who have insurance coverage through a state or federal healthcare program, including Medicare, Medicaid, Medigap, CHAMPUS, Tricare, Veterans Affairs (VA), or Department of Defense (DoD), are not eligible. Patients who move from commercial to federal health insurance will no longer be eligible.
  • Patients or their guardian must be 18 years of age or older.
  • For eligible commercially insured patients, the patient pays $5 out-of-pocket drug cost per one-month supply of ORENCIA. The Program covers a maximum of $15,000 in co-pays per calendar year (excluding certain dispensing costs).
  • For ORENCIA subcutaneous self-injection, the Co-pay Assistance Card must be presented at the pharmacy, along with a valid prescription for ORENCIA, at the time of purchase.
  • The Card must be activated before use and includes 13 uses per calendar year. The Card expires at the end of the calendar year following activation. Upon expiration, eligible patients may re-enroll using the same card.
  • For ORENCIA IV infusion, in order to receive Program benefits, the patient or provider must submit an Explanation of Benefits (EOB) form or a Remittance Advice (RA). The submitted form must include the name of the insurer, plan information, show that ORENCIA IV was the medication given, and be submitted within 180 days of the date of the EOB. The enrollment period is 1 calendar year. The Program may apply to out-of-pocket expenses that occurred within 180 days prior to the date of enrollment.
  • Program benefits are limited to the co-pay costs for ORENCIA that the patient receives as an outpatient. The Program will not cover the cost of any dosing procedure, any other healthcare provider service, supply charges, or other treatment costs.
  • Program payments are for the benefit of the patient only.
  • Patients, guardians, pharmacists, and healthcare providers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this Program.
  • 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 the patient’s insurance provider.
  • Offer valid only in the United States and Puerto Rico; void where prohibited by law, taxed, or restricted.
  • Program benefits are nontransferable. This offer may not be combined with any other rebate/coupon, free trial, or similar offer.
  • Co-pay cards are limited to 1 per patient and may not be sold, purchased, traded, or counterfeited. Reproductions of the Co-pay Card are void.
  • No membership fees.
  • Program offer is not conditioned on any past, present, or future purchase, including additional doses or refills.
  • The Program is not insurance.
  • Bristol Myers Squibb reserves the right to rescind, revoke, or amend this offer at any time without notice.