BMSPAF: Bristol-Myers Squibb Patient Assistance Foundation - Application Process
 
 
Application Process
  1. Call 1-800-736-0003. A Patient Assistance Counselor will answer any questions you have and fax or mail you an application. Or print the application here.
  2. Complete and sign the application. You will see that there is a section for you to fill out and a different section for your doctor (or other healthcare provider who can prescribe medicines) to fill out. Answer all the questions in your section. Do not leave any sections blank. If a question does not apply to you, put N/A in the answer area. Be sure to sign the application.
  3. Bring your completed application to your doctor’s (healthcare provider's) office. Have your doctor/healthcare provider complete his or her sections of the application. Make sure your provider signs the application.
  4. Make a photocopy of your proof of income, for example, your most recent tax return. You will need to send us this proof of income when you send in your application.
  5. Make sure you have read and signed your application. We cannot process applications that are not signed.
  6. Mail or fax the completed and signed application plus your proof of income to the Bristol-Myers Squibb Patient Assistance Foundation, Inc.
    The mailing address is:
    Bristol-Myers Squibb
    Patient Assistance Foundation, Inc.
    PO Box 220769
    Charlotte, NC 28222-0769

    Phone 800-736-0003
    Fax 800-736-1611
  7. The Bristol-Myers Squibb Patient Assistance Foundation, Inc. will take about 2 business days to review your application. If the application is missing information, the review will take longer.
  8. The Bristol-Myers Squibb Patient Assistance Foundation, Inc. will send you a letter to tell you whether or not you are eligible for help with your Bristol-Myers Squibb medications.