Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 4.
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Bristol Myers Squibb (BMS) Patient Support Program (Expanded: COVID-19)

This program provides brand name medications at no or low cost

Provided by: Bristol-Myers Squibb Company


TEL: 800-721-8909


Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Bristol Myers Squibb (BMS) Patient Support Program (Expanded: COVID-19)

Bristol Myers Squibb (BMS) Patient Support Program (Expanded: COVID-19) (Spanish)

 

Medications

  • abatacept injection; iv (Orencia) Injection; IV
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Determined case by case
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside in the US
   

Application

Obtaining Call
Receiving Not specified
Returning Not specified
Doctor's Action Not specified
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Call for decision
Decision Timeframe Varies
   

Medication

Amount/Supply Varies
Sent To Varies
Delivery Time Varies
Refill Process Not specified
Limit Contact the program for details
Re-application Determined case by case
   

Additional Information

Eligibility determined on a case-by-case basis. Contact program for details: 1-800-721-8909

Updated August 24, 2020


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 4.
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Bristol-Myers Squibb Patient Assistance Foundation

This program provides brand name medications at no or low cost

Provided by: Bristol-Myers Squibb Company

PO Box 220769
Charlotte, NC 28222-0769

TEL: 800-736-0003


FAX: 800-736-1611
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Bristol-Myers Squibb Patient Assistance Foundation Application

Bristol-Myers Squibb Patient Assistance Foundation Application (Zeposia)

 

Medications

  • abatacept injection; iv (Orencia) Injection; IV
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Considered on exception basis
Income At or below 300% 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
   

Application

Obtaining Call or download
Receiving Faxed
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within a week
   

Medication

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

Co-payment assistance and patient assistance programs are available for eligible patients.

Updated August 11, 2020


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 4.
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BMS Access Support (Rheumatology)

This is a copay assistance program

Provided by: Bristol-Myers Squibb Company

BMS Access Support
PO Box 221509
Charlotte, NC 28222-1509

TEL: 800-861-0048


FAX: 866-268-5385
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

BMS Access Support Program Enrollment Form (Rheumatology)

 

Medications

  • abatacept injection; iv (Orencia) Injection; IV
 

Eligibility Requirements   

Insurance Status Contact program for details.
Those with Part D Eligible? Contact program for details.
Income Not disclosed
Diagnosis/Medical Criteria Varies
US Residency Required? Must be residing in the US or Puerto Rico
   

Application

Obtaining Call or download
Receiving Downloaded from website
Returning Fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Doctor notified
Decision Timeframe 2 business days, once application process is complete
   

Medication

Amount/Supply Contact the program for more details.
Sent To Doctor's office or infusion site
Delivery Time Not specified
Refill Process Contact program for details.
Limit Varies
Re-application Must re-enroll at end of calendar year
   

Additional Information

This program also provides copay assistance.

Absent a change in Massachusetts law, effective December 31, 2020,
Massachusetts residents will no longer be able to participate in
this Program.

Updated August 24, 2020


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 4 of 4.
 

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


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

  • abatacept injection; iv (Orencia) Injection; IV
 

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 FDA Approved Diagnosis - See Program Website for Details
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 September 01, 2020