Eliquis Prescription Assistance Programs

Eliquis: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Eliquis. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Bristol-Myers Squibb Patient Assistance Foundation

(Program 1 of 1 — Scroll down to see them all )

Provided by: Bristol-Myers Squibb Company
PO Box 220769 Charlotte, NC 28222-0769
TEL: 800-736-0003
FAX: 800-736-1611
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Eliquis (apixaban)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? Considered on exception basis
  • Income At or below 300% of FPL
  • Diagnosis/Medical Criteria Medication must be for outpatient use only
  • U.S. Residency Required? The patient must reside in the US, Puerto Rico or the USVI.
Application
  • Obtaining Call or download
  • Receiving Faxed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within a week
Medication
  • Amount/Supply Varies
  • Sent To Doctor's office
  • Delivery Time Within 5-7 business days
  • Refill Proces Doctor/Doctor's office must contact company
  • Limit None
  • Re-application New application yearly
Additional Information
Co-payment assistance and patient assistance programs are available for eligible patients.
Updated May 28, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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