Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 1 of 1.  Updated March 12, 2013 Back | Print Page

This program provides brand name medications at no or low cost.

Bristol-Myers Squibb Patient Assistance Foundation

Provided by:


Bristol-Myers Squibb Company
PO Box 220769
Charlotte, NC 28222-0769

TEL: 800-736-0003


ALT PHONE:
FAX: 800-736-1611
 Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications

 

Medications

Abilify DISCMELT Tablet 10mg, 15mg (aripiprazole)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? Considered on exception basis
Income At or below 250% of FPL
Diagnosis/Medical Criteria Medication must be for outpatient use only
US Residency Required? Must reside in the US, Puerto Rico or the USVI
Obtaining Call or download
Receiving Faxed
Returning Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within a week
Amount/Supply Varies
Sent To Doctor's office
Delivery Time Within 5-7 business days
Refill Process Doctor/doctor's office must contact company
Limit None
Re-application New application yearly

Additional Information:




Read our privacy policy.

Copyright ©2013 by NeedyMeds, Inc.
Contents may not be reproduced in any form
except for personal use
and may not be used on any other website without permission.

NeedyMeds makes every effort to ensure the accuracy of the information on the website.
However, we can't guarantee the accuracy or completeness of the information.
Always check with the individual program if you have questions.