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.
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.
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.