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| Program Contact Info / Application Submission |
| Program | Bristol-Myers Squibb Americares Oncology Access Program | | Company | BrisMyrOnc | | Form | Download PDF | | Address | PO Box 991 Somerville, NJ 08876 | | Phone | 800-736-0003, opt 2 | | Fax | 866-694-2545 | | |
| Program Details |
| Details | The medication is sent to the doctor's office. A refill/reorder form is included with each shipment that must be filled out and returned to get the next shipment. Every 6 months a new application is needed.
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| 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 insurance information.
| | Details | Proof of Income NOT required
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| Delivery of Medication |
| Delivery Options | Can NOT be delivered directly to the patient
Can NOT be delivered directly to the doctor
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| Application Process |
| App Process | Anyone requesting assistance can call to request a faxed application or download it from the website. The application is faxed to the doctor's office. The completed application must be faxed back. The doctor is notified of acceptance or denial. The decision is usually made within 48 hours.
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| Eligibility |
| Eligibility | The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. The patient must also be a US resident or legal alien. Applicants must fill out two forms, one for the patient assistance program and one for benefits investigation. Call 800-861-0048. If the patient is eligible for Medicare Part D but has not enrolled then s/he may still be eligible for this program. Patients who are enrolled in Medicare, Part D who are in the 'Donut Hole' may still be eligible and should apply, but will need to submit additional information stating that are in the 'Donut Hole.'
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| Other Medications |
Other
Medications
available in
this program | |
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