Drug Information
Drug	Abilify
Generic Equivalent	aripiprazole
Class	antipsychotic
Topic	Neuro/ Mental Health
Program Contact Info / Application Submission
Program	Bristol-Myers Squibb Patient Assistance Foundation, Inc. (Abilify)
Company	BrisMyrAbilify
Form	Download PDF
Address	PO Box 8309 Somerville, NJ 08876
Phone	800-736-0003, opt 3
Fax	866-598-5561
Program Details
Details	Up to a 90-day supply is sent to the doctor's office. The patient or doctor must contact the company for refills. Every year a new application is needed
Program Requirements
Information	The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application, and attach proof of income and any denial letters from insurance companies
Details	Insurance card NOT required Drivers license required Proof of Income NOT required Copy of most recent tax return such as 1040, 1099 NOT required as proof of income Letter from Doctor stating zero incomeNOT required as proof of income Form 4506T (If taxes were not filed) required as proof of income Most recent bank statements NOT required as proof of income Most recent check/check stub copy NOT required as proof of income Letter from employer NOT required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement NOT required as proof of income Award Letter for Alimony/Child Support, Unemployment NOT required as proof of income Notarized statement from patient stating zero income NOT required as proof of income
Delivery of Medication
Ship Time	3-5 Business days
Delivery Options	Can be delivered directly to the patient Can NOT be delivered directly to the doctor Shipped as a voucher card
Application Process
App Process	With the patient's permission, anyone concerned can call for an application. The application will be faxed out. The completed application can be faxed or mailed back. Both the patient and doctor are notified in writing of acceptance or denial. The decision is usually made within 48 hours. The medication is shipped the next day.
New Applications	New applications NOT accepted Patients can NOT apply directly to the program Doctors can NOT apply directly to the program Advocates can NOT apply directly to the program Can apply for a new application via phone Can NOT apply for a new application via fax Can NOT apply for a new application via mail
Refills	Refills NOT accepted Patients can NOT apply for refills Doctors can NOT apply for refills Advocates can NOT apply for refills Can apply for refills via phone Can NOT apply for refills via fax Can NOT apply for refills via mail
Re-Applications	Re-Applications NOT accepted Patients can NOT apply for Re-Applications Doctors can NOT apply for Re-Applications Advocates can NOT apply for Re-Applications Can Re-Apply via phone Can NOT Re-Apply via fax Can NOT Re-Apply via mail
Appeals	Income Appeals NOT accepted Patients can NOT apply for Income Appeals Doctors can NOT apply for Income Appeals Advocates can NOT apply for Income Appeals Hardship Appeals NOT accepted Patients can NOT apply for Hardship Appeals Doctors can NOT apply for Hardship Appeals Advocates can NOT apply for Hardship Appeals Can apply for an appeal via phone Can NOT apply for an appeal via fax Can NOT apply for an appeal via mail
Eligibility
Eligibility	The patient cannot have prescription insurance, be ineligible for any federal or state programs and meet income guidelines that are not disclosed. The patient must also be a US citizen. If a patient enrolls in Medicare Part D, then s/he is no longer eligible for this program. If the patient chooses not to to enroll in Part D then s/he is still eligible to be on this program.
Limitations	Patients are NOT eligible if LIS is denied Patients are eligible with existing prescription coverage Patients are eligible if prescription is not covered Patients are eligible if prescription coverage has been exhausted Patients are NOT eligible if they are accepting Medicare Patients are NOT eligible if they are accepting Medicare part D Patients are NOT eligible if the medication is not covered under Medicare Patients are NOT eligible if Medicare coverage has been exhausted
Appeals
Conditions	Appeals will NOT consider out-of-pocket expenses Appeals will NOT consider total medical expenses Appeals may be made before the patient has been denied
Other Medications
Other  Medications  available in  this program	Abilify - antipsychotic Neuro/ Mental Health (Generic: aripiprazole)