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.

To enroll or conduct a Benefits Review, please visit this site from your desktop computer.

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.

 

English Enrollment Form
Download

Spanish Enrollment Form
Download

Completed forms should be faxed to 1-800-822-2496.

A completed form requires signatures from both physician AND patient. For convenience, patients can sign their Patient Authorization and Agreement Form electronically by clicking here.
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.

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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©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.

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