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Bristol-Myers Squibb Access Virology Patient Assistance Program
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6900 College Blvd
Suite 1000
Overland Park, KS 66211
Phone
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888-281-8981
Fax:
888-281-8985
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Eligibility
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The patient must have no prescription coverage for the medication or coverage must have been denied and have an income at or below 300% 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. They may be able to help those who have met their cap and are having difficulty paying for medication. A language line is available. |
| Who Can Apply
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The doctor or patient can call to request an application. |
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Required
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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. |
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Supply
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Ship To
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Doctor's office or Patient's home. |
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Note
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The doctor or patient can call to request an application. |
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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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| Sustiva Tablets 600mg (efavirenz) |
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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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