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Program Details

BRISTOL-MYERS SQUIBB
BMS Access Support Program for Oncology

Opdivo Injection (nivolumab)
 
CONTACT INFO
Address: PO Box 221509
Somerville, NJ 08876
Phone: 1-800-861-0048 Provider Phone:
Fax: 1-888-776-2370 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Contact program for eligibility information.
  • Patients with Medicare Part D are not eligible.
  • Co-pay assistance is also available.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Physician License #
    Required:
    Both DEA and State
    NPI
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Provider
    MEDICATION
    Receives: Medication
    Shipped To: Varies
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: New application every 12 months
    New financial information every 12 months
    Refill Policy: Not Published
    Other Information:
  • This program provides the screening for the Bristol-Myers Squibb Patient Assistance Foundation (BMSPAF) Oncology Patient Assistance Program.
  • Last Updated: 10/19/2021

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)



     

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