Your Patients
Help patients find transportation, medical services, care at home, and other healthcare-related resources.
This site is operated by a third party and is not affiliated with Bristol Myers Squibb.
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.
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
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.
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.
2003-US-2100246 06/21
©2022 Bristol-Myers Squibb Company. 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 04/22.
2003-US-2100513 04/22