BMSPAF: Bristol-Myers Squibb Patient Assistance Foundation - Application Process
U.S. Residents Only. Questions? Call Us at 1-800-736-0003. Apply now by downloading our online application form General Application
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 for Empliciti,Opdivo, Sprycel or Yervoy, please call 1-800‐736‐0003.
  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 sure you have read and signed your application. We cannot process applications that are not signed.
  5. Mail or fax the completed and signed application to the Bristol-Myers Squibb Patient Assistance Foundation, Inc to the address or fax number noted on the application.
  6. The Bristol-Myers Squibb Patient Assistance Foundation, Inc. will take about 2 business days to review your application. If the application is missing information, an associate will contact you or your healthcare provider.
  7. The Bristol-Myers Squibb Patient Assistance Foundation, Inc. will contact you to tell you whether or not you are eligible for help with your Bristol-Myers Squibb medications.

Donors to the Bristol-Myers Squibb Patient Assistance Foundation, Inc.

Bristol-Myers Squibb is a global BioPharma company firmly focused on its mission to discover, develop and deliver innovative medicines that help patients prevail over serious diseases. Around the world, our medicines help millions of people in their fight against serious diseases.

Please note that site is not intended for the reporting of side effects associated with the use of prescription drugs. If you, or someone you know, have possibly experienced a side effect while taking a medication listed on this site, please contact Bristol-Myers Squibb Company at: 800-321-1335 (toll free US only).