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Patient Assistance Information

 
1 Program for Abilify DISCMELT 10mg, 15mg (aripiprazole)
 
 
Bristol-Myers Squibb Patient Assistance Foundation Program for Abilify

PO Box 8309
Somerville, NJ 08876
Phone : 800-736-0003 Ext 3
Fax: 866-598-5561
Eligibility
> The patient must have no prescription coverage for any medications. The patient must have an income at or below 250% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must reside in the US, Puerto Rico or the USVI. Medicare Part D enrollees may apply for assistance through a case by case appeals process based on significant financial and medical need.
Who Can Apply
> With the patient's permission, anyone concerned can call for an application.
Required
> The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application, and attach proof of income.
Supply
> Up to a 90-day supply
Ship To
> The medication is shipped to the healthcare provider's physical office address. They cannot ship to the patient's home or a PO Box.
Note
>
 
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.
 
Abilify DISCMELT 10mg, 15mg (aripiprazole)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader