Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
1 Program for Baraclude Oral Solution (entecavir)
 
 
Bristol-Myers Squibb Baraclude Patient Assistance Program

6900 College Blvd.
Suite 1000
Overland Park, KS 66211
Phone : (855)898-0267
Fax: (855)286-6831
Eligibility
> 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
> 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.
Required
>
Supply
> Not specified.
Ship To
> 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.
Note
> A new yearly application is required.
 
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.
 
Baraclude Oral Solution 210 ml (entecavir)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader