The Financial Challenge of Yervoy for Your Patients

Yervoy (ipilimumab) is a critical immunotherapy for patients with advanced melanoma, renal cell carcinoma, NSCLC, mesothelioma, and other malignancies. It is also one of the most expensive oncology drugs on the market. With a single 200 mg vial priced at approximately $35,387 and a full melanoma monotherapy course (4 doses at 3 mg/kg every 3 weeks) potentially exceeding $120,000 to $150,000, out-of-pocket costs can be devastating — even for insured patients.

As a prescribing provider, you play a central role in connecting patients with financial assistance. Many patients are unaware that programs exist, and those who know about them often need help navigating the enrollment process. This guide consolidates the key savings programs and billing strategies available for Yervoy in 2026.

For a complementary patient-facing resource, see our patient guide to saving money on Yervoy.

Bristol Myers Squibb Co-Pay Assistance Program

BMS offers a co-pay assistance program specifically for commercially insured patients receiving Yervoy. Key details:

• Eligibility: Patients with commercial (private) insurance who have out-of-pocket costs for Yervoy. Not available to patients on Medicare, Medicaid, Tricare, or other government-funded programs.
• Coverage: Helps cover co-payment or co-insurance costs for Yervoy infusions.
• Enrollment: Contact BMS Access Support at 1-800-861-0048. Your office staff can initiate enrollment on behalf of the patient.
• Renewal: Typically needs to be renewed annually. Set calendar reminders for your patients who are on ongoing treatment.

This program can significantly reduce or eliminate the co-pay burden for commercially insured patients. Encourage your billing team to enroll eligible patients proactively at the start of treatment.

Bristol Myers Squibb Patient Assistance Foundation (BMSPAF)

For uninsured patients or those experiencing significant financial hardship, the BMS Patient Assistance Foundation provides Yervoy at no cost. Details:

• Eligibility: Uninsured patients who meet income and asset criteria. Some underinsured patients may also qualify.
• Application: Requires a completed application form, proof of income, and a prescription from the treating physician.
• Contact: 1-800-736-0003 or visit bmspaf.org.
• Processing time: Typically 5-10 business days. Start the application well before the first scheduled infusion.

Your office can designate a staff member or financial counselor to manage PAP applications. Given Yervoy's cost, this program is essential for uninsured patients who would otherwise be unable to access treatment.

Independent Charitable Foundations

Several independent foundations provide co-pay assistance for patients with cancer, including those on Yervoy. These are particularly valuable for Medicare patients, who are ineligible for manufacturer co-pay programs due to federal anti-kickback regulations.

Key Foundations to Know

• PAN Foundation (Patient Access Network) — Offers co-pay assistance for various cancer diagnoses. Fund availability fluctuates, so check panfoundation.org regularly and apply as soon as a relevant fund opens.
• Patient Advocate Foundation (PAF) Co-Pay Relief — Provides direct financial assistance for co-pays related to specific diagnoses. Visit copays.org.
• CancerCare — Offers limited financial assistance grants for cancer patients. Visit cancercare.org.
• The Assistance Fund (TAF) — Provides co-pay assistance for specific disease categories. Check tafcares.org.
• HealthWell Foundation — Another co-pay assistance option for specific diagnoses. Visit healthwellfoundation.org.

Pro tip: Foundation funds for oncology diagnoses often open and close quickly due to high demand. Assign a staff member to monitor fund status weekly and submit applications immediately when funds become available.

Medicare Part B Coverage and Cost Sharing

Yervoy is covered under Medicare Part B as a physician-administered drug. Understanding the billing structure helps you anticipate patient costs:

• Medicare pays 80% of the approved amount after the Part B deductible is met.
• Patient responsibility: 20% co-insurance, which for Yervoy can amount to thousands of dollars per infusion.
• Medigap policies: Patients with supplemental Medicare coverage may have their 20% co-insurance partially or fully covered. Encourage patients to review their Medigap policy benefits.
• Medicare Advantage: Cost sharing varies by plan. Verify benefits before starting treatment.

For Medicare patients facing high co-insurance, the independent foundations listed above are the primary option for financial assistance.

Prior Authorization Best Practices

Most payers require prior authorization for Yervoy. Delays in authorization can delay treatment. Streamline the process with these practices:

• Submit early. Initiate prior authorization as soon as the treatment decision is made — ideally 2-3 weeks before the planned first infusion.
• Include supporting documentation. Pathology reports, staging information, relevant biomarker results (e.g., MSI-H/dMMR status, PD-L1 expression), and treatment rationale supporting the FDA-approved indication.
• Know payer-specific requirements. Some payers require step therapy documentation (e.g., prior sorafenib treatment for HCC indication). Have this documented clearly.
• Appeal denials promptly. If authorization is denied, file an appeal with supporting clinical literature and NCCN guidelines. Include a peer-to-peer review request if available.
• Use BMS Access Support. BMS offers reimbursement support services that can help with prior authorization, appeals, and benefit verification. Contact 1-800-861-0048.

Billing and Coding Considerations

Proper billing ensures your practice is reimbursed and minimizes patient billing issues:

• HCPCS code: J9228 (ipilimumab injection, 1 mg). Bill based on the actual number of milligrams administered.
• Diagnosis codes: Use the most specific ICD-10 code for the patient's cancer type and stage.
• Site of service: Yervoy administered in the office setting may have different reimbursement than hospital outpatient. Verify payer policies.
• Waste documentation: If a vial is partially used, document waste according to payer requirements. Some payers reimburse for discarded drug; others do not.
• Buy-and-bill considerations: Yervoy is typically acquired through specialty distributors under buy-and-bill. Monitor ASP (Average Sales Price) reimbursement rates, as these are updated quarterly by CMS for Medicare.

Connecting Patients with Additional Resources

Beyond direct financial assistance, point patients toward these resources:

• NeedyMeds (needymeds.org) — A comprehensive database of patient assistance programs, co-pay cards, and discount resources.
• RxAssist (rxassist.org) — Another directory of pharmaceutical assistance programs.
• Cancer Financial Assistance Coalition (CFAC) — A coalition of organizations providing financial help to cancer patients.
• Social work referral: If your practice has an oncology social worker, involve them early. They can help patients navigate insurance issues, apply for programs, and access local community resources.
• MedFinder for Providers — Use MedFinder's provider tools to help patients locate Yervoy availability and connect with savings resources.

Addressing the Biosimilar Horizon

Yervoy's core U.S. patent expired in March 2025. Biosimilar candidates (including development from Sandoz/Henlius) are in the pipeline but have not yet reached FDA approval as of early 2026. When a biosimilar becomes available:

• It could reduce acquisition costs by 15-40%, following patterns seen with other oncology biosimilars.
• Payers may implement biosimilar-preferred policies or step therapy requiring biosimilar use before the reference product.
• Educate patients proactively that biosimilars are clinically equivalent and not "inferior" versions of the drug.

Stay current with FDA approvals and payer policy changes so you can adjust your prescribing and financial counseling accordingly.

Building a Financial Support Workflow

The most effective practices build financial screening into the treatment initiation process:

1. At treatment planning: Conduct a financial screening to identify patients at risk for high out-of-pocket costs.
2. Before first infusion: Verify insurance, complete prior authorization, and enroll eligible patients in co-pay assistance or PAPs.
3. Ongoing: Monitor foundation fund availability, renew co-pay assistance annually, and reassess patients whose insurance status changes.
4. At treatment completion: Ensure no outstanding balances related to Yervoy infusions and close out assistance program enrollments.

For related provider resources, see our guides on managing Yervoy shortages and helping patients find Yervoy in stock.