Program Applications

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Tips for using the applications:

  • You will need Adobe Reader to open the applications. Download this free program or the latest version, which is recommended.
  • Click the button in the top right of the application to turn on the Highlight Fields Option which will highlight the fields to be filled out.
  • Use the "tab" key to easily go to the next field.

As of 07/16/2018 there are 584 applications available.

Click on the first letter of the name of the program. Then click on the application for that program. Dates next to each listing reflect the last update. Some applications may need to be opened with a different viewer depending on which browser you are using. Firefox users may get a message saying "This PDF document might not be displayed correctly." Try clicking on the "Open With Different Viewer" option. If you are still unable to interactively complete the application, use a different browser.

Send the completed application to the address on the application and not to NeedyMeds.

If you cannot find an application or are having trouble printing one, contact the program or company.

Contact NeedyMeds if you find any content errors.

For link problems or other technical problems, send an email to webmaster.

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Baraclude All in One Access Program Application 04/19/18
Bayer Access Solutions Form 07/16/18
Bayer Patient Assistance Program Application 03/23/18
Benlysta Gateway Co-Pay Services Form Enrollment for Benlysta (SC) (IV) 06/18/18
Benlysta Gateway PAP Services Form 06/18/18
Betaseron Patient Assistance Program Enrollment Application: Contact program
BioMarin Rare Connections Patient Enrollment Form 04/12/18
Bioventus Patient Assistance Product Request Form (Gelsyn-3) 04/05/18
Bioventus Patient Assistance Product Request Form (Supartz FX) 04/05/18
Bioverativ Program Enrollment Form (Alprolix) 05/07/18
Bioverativ Program Enrollment Form (Eloctate) 05/07/18
BMS Access Support Kidney Transplant Support Enrollment Form 04/19/18
BMS Access Support Kidney Transplant Support Patient Authorization & Agreement Form 04/19/18
BMS Access Support Patient Authorization & Agreement Form (Oncology) 04/19/18
BMS Access Support Patient Authorization & Agreement Form (Rheumatology) 04/19/18
BMS Access Support Program Enrollment Form (Oncology) 04/19/18
BMS Access Support Program Enrollment Form (Rheumatology) 04/19/18
BMS Oncology Co-Pay Enrollment Form (Opdivo & Yervoy Regimen) 04/19/18
BMS Patient Support Connect Enrollment Form 04/19/18
BMS3assist Co-Pay Assist for Atripla, Evotaz, Reyataz and Sustiva: Contact Program
Boehringer Ingelheim Cares Application 06/18/18
Botox Patient Assistance Program Application 07/16/18
Braeburn Access Probuphine Co-Pay/Co-Insurance Assistance 06/14/18
Braeburn Access Program Probuphine Implant Patient Enrollment Form 06/14/18
Bristol-Myers Squibb Access Virology Patient Assistance Program Application 04/19/18
Bristol-Myers Squibb Patient Assistance Foundation Application 05/08/18
ByMySide Support Program Enrollment Form: Contact program

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