BMS Access Support ® offers both online and fax enrollment.
Start here to conduct a benefits review, initiate assistance with prior authorizations and appeals, and request financial support program enrollment for eligible patients. Once the enrollment form has been submitted and a benefits review has been conducted, you will receive your patient’s summary of healthcare benefits.
Select the appropriate medication below to begin online enrollment. Once you complete your portion of the enrollment form, your patient will receive an email prompting them to complete and sign their portion of the form. Enrollment is not complete until the patient form has been completed and signed.
To start, please
Select a Medication
Need help getting started? Download our
Online Enrollment User Guide.
If you prefer to manually complete the enrollment process, please download the appropriate enrollment form below based on the product your patient has been prescribed and fax the completed form to the number listed on the form.
Download form for:
AUGTYRO™ (repotrectinib)
EMPLICITI ® (elotuzumab)
KRAZATI ® (adagrasib)
OPDIVO ® (nivolumab) and OPDIVO Combination
OPDUALAG ™ (nivolumab and relatlimab-rmbw)
SPRYCEL ® (dasatinib)
YERVOY ® (ipilimumab)
Download form for:
ABRAXANE ® (paclitaxel protein-bound particles for injectable suspension) (albumin-bound)
IDHIFA ® (enasidenib)
INREBIC ® (fedratinib)
ONUREG ® (azacitidine)
POMALYST ® (pomalidomide)
REBLOZYL ® (luspatercept-aamt)
REVLIMID ® (lenalidomide)
THALOMID ® (thalidomide)
Download form for:
NULOJIX ® (belatacept)
Note, a completed form requires signatures from both physician AND patient. Completed forms should be faxed to the number provided on the form.
If your office prefers to complete enrollment manually via fax but your patient is not present, patients can sign their Patient Authorization and Agreement form electronically. Visit the patient e-signature portal.
Download a helpful benefits and coverage form for patients.
Watch this video to learn about the enrollment process for BMS Access Support.
Enroll, track, and manage your patient cases in real time for select BMS medications.*
*Selected medications include AUGTYRO™ (repotrectinib), EMPLICITI ® (elotuzumab), KRAZATI ® (adagrasib), OPDIVO ® (nivolumab), OPDUALAG ™ (nivolumab and relatlimab-rmbw), SPRYCEL ® (dasatinib), and YERVOY ® (ipilimumab).
Bristol Myers Squibb is committed to helping appropriate patients get access to our medications by providing access and reimbursement support services.
The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.
The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.
Speak with a Patient Access Specialist
Schedule a Call
Speak with a Patient Access Specialist
Schedule a Call
Meet with an Access and Reimbursement Manager
Request a Visit
Glossary of Terms
What can we help you with?
What can we help you with?
© 2024 Bristol-Myers Squibb Company. IDHIFA is a trademark of Celgene Corporation, a Bristol Myers Squibb company. Access Support is a registered trademark of Bristol-Myers Squibb Company. ABRAXANE ® is a registered trademark of Abraxis BioScience, LLC. Abraxis BioScience, LLC is a wholly owned subsidiary of Bristol-Myers Squibb Company. IDHIFA is licensed from Servier Pharmaceuticals, LLC. INREBIC ® is a trademark of Impact Biomedicines, Inc.
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