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| 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 | | |
| Delivery of Medication |
| Ship Time | 3-5 Business days | | |
| 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.
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| 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.
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| Other Medications |
Other
Medications
available in
this program | |
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