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Program Details

BRISTOL-MYERS SQUIBB
BMS Access Support
Pomalyst capsule (pomalidomide)
 
CONTACT INFO
Address:
,
Phone: 1-800-861-0048 Provider Phone:
Fax: Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Note: This program provides screening for the Bristol-Myers Squibb Patient Assistance Foundation Patient Assistance Program.
  • Patients with Medicare Part D may be eligible, contact program for details.
  • Co-pay assistance, patient support, and patient assistance programs are available for eligible patients.
    • Income at or below: Not Published
    Medical expenses can be deducted from reported income: No
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Physician License #
    Required:    		 State
    NPI
    Prescriber Signature
    Allowed:    		 Physician
    Application may be
    faxed:    		 Yes
    Eligibility determination
    letter sent:    		 Provider
    MEDICATION
    Receives: Medication
    Shipped To: Either Provider and Patient
    Quantity in Shipment: Varies
    Delivery Time: Not Published
    Re-application Policy: Must re-enroll at end of calendar year
    Refill Policy: Patient or physician's office must contact the program
    Other Information:

    Last Updated: 02/28/2024

    		  

     

     


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


    Document Oncology Access - Drug Set 1


    Document Oncology Access - Drug Set 2

     

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