Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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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

  • apixaban tablet (Eliquis) Tablet
 

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 2.
 

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

  • apixaban tablet (Eliquis) Tablet
 

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