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Download the Enrollment bFormb - Bristol-Myers Squibb Access Support - needymeds

Download the Enrollment bFormb - Bristol-Myers Squibb Access Support - needymeds 2025

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The document outlines the Bristol-Myers Squibb Access Support Program, which provides reimbursement assistance for patients undergoing kidney transplants and using the medication NULOJIX (belatacept). It details services offered, eligibility criteria for co-pay assistance, registration steps for healthcare providers and patients, and terms and conditions of the program. The program aims to help patients navigate insurance benefits, obtain financial support, and manage out-of-pocket costs related to their treatment.

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Click ‘Get Form’ to open it in the editor.
Begin by selecting the desired services at the top of the Enrollment Form on page 3. This section allows you to indicate whether you are applying for benefit investigation, appeals, or co-pay assistance.
Complete the Provider sections with accurate information, including the treating physician's DEA#, state license number, and NPI number. Ensure all details are correct to avoid processing delays.
For patients applying for co-pay assistance, read and sign the co-pay agreement. This is crucial for eligibility in receiving financial support.
Patients should fill out their personal information in the designated section, including name, date of birth, and insurance details. Make sure to check all applicable insurance options.
Finally, both healthcare providers and patients must sign and date their respective sections before faxing the completed form to BMS Access Support at 1-888-776-2370.

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What is the BMS copay assistance program?

The BMS Access Support Co-Pay Assistance Program helps commercially insured patients who have been prescribed select BMS medications with out-of-pocket deductibles, co-pays, or co-insurance requirements. Eligible patients may pay as little as $0 per one-month supply, subject to a maximum benefit. Restrictions apply.

What is a copay assistance program?

Copay assistance programs are funded by pharmaceutical companies to alleviate commercial insured patient out-of-pocket medical expenses associated with patients infusions or clinic-administered medicines.

What is the Bristol Myers Squibb Assistance Program?

Assistance for uninsured patients. Visit bmspaf.org or call 800-736-0003 for more information about an independent charitable program that provides free medication to eligible, uninsured patients who are experiencing financial hardship.

What is the Bristol Myers Squibb medication assistance program?

Visit bmspaf.org or call 800-736-0003 for more information about an independent charitable program that provides free medication to eligible, uninsured patients who are experiencing financial hardship.

What is the income limit for Bristol Myers Squibb patient assistance?

BMS Access Support, the Bristol Myers Squibb reimbursement services program, offers benefits investigation, prior authorization support, and appeals assistance. Program counselors are available Monday through Friday, from 8 AM to 8 PM ET at 1-800-861-0048.

Is co-pay relief legitimate for Medicare?

Yes, all payments that are made on your behalf for pharmaceutical products prescribed to treat and manage your disease and is covered by your Medicare Part D plan will be counted towards your true out-of-pocket costs (TrOOP) for the calendar year.

Download the Enrollment bFormb - Bristol-Myers Squibb Access Support - needymeds 2025

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Download the Enrollment bFormb - Bristol-Myers Squibb Access Support - needymeds 2025

Here's how it works

How to use or fill out Download the Enrollment Form - Bristol-Myers Squibb Access Support - needymeds

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Complete this form in 5 minutes or less

Got questions?

Can I use DocHub to create legal eSignatures on my Download the Enrollment bFormb - Bristol-Myers Squibb Access Support - needymeds?

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What is the BMS copay assistance program?

What is a copay assistance program?

What is the Bristol Myers Squibb Assistance Program?

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