Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 3.
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Bristol-Myers Squibb Access Virology Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Bristol-Myers Squibb Company

PO Box 221430
Charlotte, NC 28222-1430

TEL: 888-281-8981


FAX: 888-281-8985
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Bristol-Myers Squibb Access Virology Patient Assistance Program Application

HIV Common Application: Bristol-Myers Squibb (REYATAZ, SUSTIVA)

 

Medications

  • atazanavir sulfate (Reyataz) 
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage or been denied coverage
Those with Part D Eligible? Not specified
Income At or below 500% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US, Puerto Rico or the USVI
   

Application

Obtaining Call
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient and Doctor notified of acceptance
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not specified
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Company contacts Doctor to arrange
Limit Not specified
Re-application New application yearly
   

Additional Information

BMS3assist may be able to help those who have met their cap and are having difficulty paying for their medications.

Income eligibility may vary by state.

This Program participates in the CPAPA. This single common application allows uninsured HIV-positive individuals with low incomes to use one application to apply for multiple assistance programs.

IMPORTANT: Send completed CPAPA to the corresponding addresses listed for each company.


Updated August 16, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 3.
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BMS3assist Co-Pay Assist for Atripla, Evotaz, Reyataz and Sustiva

This is a copay assistance program

Provided by: Bristol-Myers Squibb Company

BMS3assist
PO Box 221430
Charlotte, NC 28222

TEL: 888-281-8981


FAX: 888-281-8985
Languages Spoken:

English

Program Website

 

Program Applications and Forms

BMS3assist Co-Pay Assist for Atripla, Evotaz, Reyataz and Sustiva: Contact Program

 

Medications

  • atazanavir sulfate (Reyataz) 
 

Eligibility Requirements   

Insurance Status Must have insurance
Those with Part D Eligible? No
Income No limits
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US, Puerto Rico or the USVI
   

Application

Obtaining Call
Receiving There is no application
Returning Not applicable
Doctor's Action Not specified
Applicant's Action Request card online or by phone
Decision Communicated Patient notified
Decision Timeframe Decision made during phone screening
   

Medication

Amount/Supply Not applicable
Sent To Varies
Delivery Time ID number given over the phone or card shipped within 7-10 business days
Refill Process Not applicable
Limit Up to one year
Re-application Must re-enroll at end of calendar year
   

Additional Information

Eligible patients may be able to save up to $7,500 per year with no monthly limit.

Patient Assistance Program also available; Contact program for details.


Updated August 16, 2017


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 3.
 

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation

PO Box 221858
Charlotte, NC 28222-1858

TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • atazanavir sulfate (Reyataz) 
 

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.


Updated June 29, 2017