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Bristol myers squibb patient assistance form 2025

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The Bristol-Myers Squibb Patient Assistance Foundation (BMSPAF) is a non-profit organization that provides eligible patients in the USA, Puerto Rico, and the U.S. Virgin Islands with free access to specific medications, including ELIQUIS®, DAKLINZA®, NULOJIX®, and ORENCIA®. Eligibility criteria include outpatient treatment, income limits, and lack of insurance coverage for the requested medication. Patients must complete an application form with personal and financial information, which may require proof of income. The document outlines the application process, required information from both patients and healthcare providers, and consent for sharing personal data.

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How can I get help paying for my Eliquis?

Anyone requesting assistance can call to request an application or download it from the website. The patient must have no prescription coverage for the requested medication and have an annual household adjusted gross income of $150,000.00 or less.

What if I cant afford my ELIQUIS?

You may be eligible for the Co-pay Card for ELIQUIS (apixaban) if: 1. You are insured by commercial insurance and your prescription insurance coverage does not cover the full cost of your prescription, that is, you have a co-pay obligation for ELIQUIS; 2.

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