Patient must be a U.S. citizen ineligible for prescription assistance through Medicaid or private insurance. Patient must meet established financial criteria. Application form, prescription, and patient's income documentation are required. Maximum of three months supply may be provided per request. Complete financial re-application is required annually.
Renewal requests within the same year require only the application form and a prescription.
Program is subject to change without notice. Current program specifics can be obtained by calling the toll-free number above. This program is designed to provide temporary assistance to patients with a financial hardship who are not eligible for prescription drug coverage through Medicaid or any other public or private health program. Patients who meet the program's eligibility criteria are provided BMS products free of charge. Other Program Information Physicians and other health care professionals who are interested in enrolling a patient should call the toll-free number above to request an application form.