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Bristol-Myers Squibb Baraclude Patient Assistance Program
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6900 College Blvd.
Suite 1000
Overland Park, KS 66211
Phone
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(855)898-0267
Fax:
(855)286-6831
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Eligibility
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The patient must have no prescription coverage or been denied coverage, have an income at or below 300% of the FPL, must reside in the US, Puerto Rico or the USVI. |
| Who Can Apply
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The patient or doctor can call for an application. The doctor must complete a section and sign. The patient must complete, sign, and attach proof of income. |
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Required
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Supply
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Not specified. |
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Ship To
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Doctor and Patient are notified of a decision within 24 hours. A card to be used at the pharmacy to obtain medication is activated on the business day following approval into the program. |
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Note
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A new yearly application is required. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Baraclude Oral Solution 210 ml (entecavir) |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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