Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 5.
Scroll down to see them all.
 

BMS Access Support (Oncology) Onureg

This program provides brand name medications at no or low cost

Provided by: Bristol-Myers Squibb Company

BMS Access Support
86 Morris Avenue
summit, NJ 07901

TEL: 800-861-0048


FAX: 800-822-2496
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

BMS Access Support Program Enrollment Form (Oncology) for Onureg

 

Medications

  • azacitidine tablet (Onureg) Tablet
 

Eligibility Requirements   

Insurance Status Contact program for details.
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
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 Varies
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 provides the screening for the Bristol-Myers Squibb Patient Assistance Foundation (BMSPAF) Oncology Patient Assistance Program.

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 September 03, 2020


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 5.
Scroll down to see them all.
 

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

  • azacitidine injection; iv or subcutaneous (Vidaza) Injection; IV or Subcutaneous
 

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 3 of 5.
Scroll down to see them all.
 

Celgene Patient Support

This program provides brand name medications at no or low cost

Provided by: Celgene Corporation

Attn: Celgene Patient Support
86 Morris Ave.
Summit, NJ 07901

TEL: 800-931-8691


FAX: 800-822-2496
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Celgene Patient Assistance Application

Celgene Patient Assistance Application (Spanish)

 

Medications

  • azacitidine injection; iv or subcutaneous (Vidaza) Injection; IV or Subcutaneous
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Contact program for details.
Income At or below 650% of FPL
Diagnosis/Medical Criteria Any diagnosis deemed medically necessary by the patient's oncologist
US Residency Required? Yes, with prescription from US doctor
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
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 of acceptance
Decision Timeframe Within 24 hours
   

Medication

Amount/Supply Amount requested is sent
Sent To Doctor's office or patient's home
Delivery Time Varies
Refill Process New prescription
Limit Maximum 6 months or 300 mg
Re-application Company contacts patient about reapplying
   

Additional Information

This program also provides copay assistance.

Updated August 13, 2020


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 4 of 5.
Scroll down to see them all.
 

HealthWell Foundation Copay Program

This is a copay assistance program

Provided by: HealthWell Foundation

PO Box 489
Buckeystown, MD 21717

TEL: 800-675-8416


FAX: 800-282-7692
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

HealthWell Foundation Copay Program Enrollment: Contact program

HealthWell Foundation COVID-19 Ancillary Costs: Contact program

 

Medications

  • azacitidine injection; iv or subcutaneous (Vidaza) Injection; IV or Subcutaneous
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Varies
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside in the US
   

Application

Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient notified in writing
Decision Timeframe 3-5 business days
   

Medication

Amount/Supply Not applicable
Sent To Varies
Delivery Time Not specified
Refill Process Good for one year
Limit Not specified
Re-application New application every 12 months
   

Additional Information

This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.

Call for most recent medications as the list is subject to change.
Updated July 20, 2020


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 5 of 5.
 

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

  • azacitidine injection; iv or subcutaneous (Vidaza) Injection; IV or Subcutaneous
 

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