|
This program provides brand name medications at no or low cost.
|
| Pharmaceutical Company |
Bristol-Myers Squibb Company |
| Program Name |
Bristol-Myers Squibb Patient Assistance Foundation: Orencia Patient Assistance Program |
| Program Address |
PO Box 991
Somerville, NJ 08876 |
| Phone Number |
800-736-0003, opt 4
|
| Fax Number |
866-694-2545 |
| Medications on Program |
Orencia Injection 250mg/ml (abatacept)
|
| Application Forms |
Bristol-Myers Squibb Patient Assistance Foundation: Orencia Patient Assistance Program
|
On-line Application
|
No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient must have no prescription coverage for any medications and meet income and other eligibility guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. The patient must be a US citizen or legal resident.
|
| Application Process |
Anyone requesting assistance can call to request a faxed application or download it from the website. The application will be faxed out. The completed application can be faxed or mailed back.
The doctor is notified of acceptance or denial.
|
| Application Requirements |
The doctor must fill out a section, sign the application, and attach a prescription and include the DEA or State License number. The patient must fill out a section, sign the application and attach proof of income.
|
| Program Details |
The medication is sent to the doctor's office. The company contacts the doctor to arrange for refills. Every year a new application is needed.
|
| Last Updated |
October 27, 2009 |
