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

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

 

Patient Assistance Applications

Bristol-Myers Squibb Patient Assistance Foundation Application

Bristol-Myers Squibb Patient Assistance Foundation Application (Zeposia)

 

Brand Name Medications

 
  • Eliquis tablet
  • Orencia injection; iv
  • Nulojix injection; iv
  • Zeposia capsule
 

Generic Name Medications

 
  • abatacept injection; iv
  • belatacept injection; iv
  • apixaban tablet
  • ozanimod capsule
 

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


Updated November 29, 2021