Bristol Myers Squibb is committed to helping appropriate patients get access to our
medications by providing access and reimbursement support services.

This information is intended for U.S. healthcare professionals and/or healthcare professionals involved in healthcare reimbursement.

BMS Access Support® Enrollment

Services can be initiated with the completion of our Enrollment Form.

Start here to begin a Benefits Review, enroll a patient in services, or initiate assistance with prior authorization requests.


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Online Enrollment

Upon completion of the physician section of this enrollment form, an automated email will be sent to your patient to complete their section of the form. Both parties must complete their sections of the form in order for enrollment to be completed.

Need help getting started?
Download our Online Enrollment User Guide

Fax Enrollment

English Enrollment Form

Spanish Enrollment Form

A completed form requires signatures from both physician AND patient. Completed forms should be faxed to 1-888-776-2370.

For convenience, patients can sign their Patient Authorization and Agreement Form electronically by clicking here.

To download and fax the enrollment form, please visit this site from your desktop computer.
A completed form requires signatures from both physician AND patient. Please visit this site from your desktop computer for more information about an electronic signature option.

My BMS Cases

Enroll, track, and manage your patient reimbursement cases in real time.

Learn How >

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.

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Support Center: 1-800-861-0048
am to 8 pm ET, Mon - Fri
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Schedule a call from a Patient Access SpecialistSchedule a Call >
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Request a visit from a BMS Access & Reimbursement ManagerRequest a Visit >
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©2022 Bristol-Myers Squibb Company. All rights reserved. Access Support is a registered trademark of Bristol-Myers Squibb Company.

Use of the information on this site is subject to the terms of our Legal Notice and Privacy Statement. The coding, coverage, and payment information contained within this website is current as of 03/22.

1506-US-2101816 03/22