For Patients Applying to the Bristol Myers Squibb Patient Assistance Foundation (BMSPAF)
Whether you are applying to BMSPAF for the first time or requesting continued assistance, your application may be processed more quickly if you include proof of your household income from a Federal Tax Return or other income documentation including:
1099 forms
Social security statements
Pension statements
Two consecutive pay stubs
Note to Medicare Patients:
In addition to your application, you will need to submit documentation showing you have spent 3% of your annual household income on out-of-pocket prescription expenses for you and/or other members of your household for the year in which you are seeking assistance. Your pharmacy can provide this report.
For example – if your annual household income is $10,000, you would need to spend at least $300 on prescription expenses for you and/or other members of your household. Prescription expenses include your out-of-pocket expenses for any prescriptions filled beginning January 1st of the year you are seeking assistance.
This 3% out-of-pocket prescription expense is in addition to our other eligibility criteria, including financial eligibility. We may not be able to process your application until we receive documentation of these out-of-pocket prescription expenses.
Kind regards,
BMSPAF
