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Bristol-Myers Squibb Patient Assistance Foundation Program for Orencia
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PO Box 991
Somerville, NJ 08876
Phone
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800-736-0003
Fax:
(866)694-2545
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Eligibility
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The patient must have no prescription coverage for the requested medication 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. |
| Who Can Apply
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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Required
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The patient and healthcare provider must complete and sign the application. The patient must also provide documentation of the annual household income and any insurance information. |
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Supply
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The Doctor’s office needs to contact the company for refills. |
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Ship To
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Product will be shipped to the Doctor’s office or infusion site. |
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Note
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You and your doctor will be notified by mail upon completion of our review and evaluation. Please note that program rules are subject to change without notice. If you have questions or need further assistance, please call (800)736-0003, between 9:00 AM and 6:00 PM Eastern Time, Monday through Friday. |
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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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| Orencia Injection 250mg/ml (abatacept) |
| Orencia Intravenous Infusion |
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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 Orencia PAP Application |
(Requires Acrobat Reader) 
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