Patient must not have private prescription drug assistance and must be unable to afford the prescription drug medication that has been prescribed. Doctor completes his or her section and signs.
Doctor attaches a dose-specific, signed prescription to the application.
Mail application to Bristol Myers Squibb Primary Care Assistance Program. Patients may reapply every 6 months. When an application is approved, it is for a 6 month period. Only a 3 month supply of product is sent initially. In the acceptance letter, the second page is a reminder to request the second 3 month supply.