| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Bristol-Myers Squibb Patient Assistance Foundation (BMSPAF)This program provides brand name medications at no or low cost |
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Provided by: Bristol-Myers Squibb Company |
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PO Box 220769 TEL: 800-736-0003FAX: 800-736-1611 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Bristol-Myers Squibb Patient Assistance Foundation Application |
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Bristol-Myers Squibb Patient Assistance Foundation Application: Zeposia |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Must have no prescription coverage for needed medication | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Varies | ||
| Diagnosis/Medical Criteria | Medication must be for outpatient use only | ||
| US Residency Required? | Must reside in the US, Puerto Rico or the USVI | ||
Application |
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| Obtaining | Call or download | ||
| Receiving | Faxed | ||
| Returning | Fax or mail | ||
| Doctor's Action | Complete section, sign, attach required documents | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Within a week | ||
Medication |
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| Amount/Supply | Varies | ||
| Sent To | Doctor's office | ||
| Delivery Time | Varies | ||
| Refill Process | Doctor/Doctor's office must contact the Program | ||
| Limit | Contact the program for details | ||
| Re-application | New application yearly | ||
Additional Information |
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| Updated April 24, 2023 | |||
