Evotaz Patient Assistance Programs

Evotaz: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Evotaz. 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 Access Virology Patient Assistance Program

(Program 1 of 3 — Scroll down to see them all )

Provided by: Bristol-Myers Squibb Company
BMS3assist PO Box 221430 Charlotte, NC 28222-1430
TEL: 888-281-8981
FAX: 888-281-8985
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Evotaz (atazanavir sulfate/cobicistat)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage or been denied coverage
  • Those with Part D Elibible? Not specified
  • Income At or below 500% of FPL
  • Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
  • U.S. Residency Required? The patient must reside in the US, Puerto Rico or the USVI.
Application
  • Obtaining Call or download
  • Receiving Faxed or mailed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient and Doctor notified of acceptance
  • Decision Timeframe Up to 5 business days
Medication
  • Amount/Supply Up to 90 day supply
  • Sent To Doctor's office or patient's home
  • Delivery Time Not specified
  • Refill Proces Company contacts Doctor to arrange
  • Limit Not specified
  • Re-application New application yearly
Additional Information
BMS3assist may be able to help those who have met their cap and are having difficulty paying for their medications. Income eligibility may vary by state. This Program participates in the CPAPA. This single common application allows uninsured HIV-positive individuals with low incomes to use one application to apply for multiple assistance programs. IMPORTANT: Send completed CPAPA to the corresponding addresses listed for each company.
Updated October 5, 2018

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BMS3assist Co-Pay Assist

(Program 2 of 3 — Scroll down to see them all )

Provided by: Bristol-Myers Squibb Company
BMS3assist PO Box 221430 Charlotte, NC 28222
TEL: 888-281-8981
Languages Spoken:
English Others By Translation Service
Program Website
Medications
  • Evotaz (atazanavir sulfate/cobicistat)
Eligibility Requirements
  • Insurance Status Must have insurance
  • Those with Part D Elibible? No
  • Income No limits
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must also be residing in the US or Puerto Rico
Application
  • Obtaining Call
  • Receiving There is no application
  • Returning The completed application's destination is not applicable
  • Doctor's Action Not specified
  • Applicant's Action Request card online or by phone
  • Decision Communicated Patient notified
  • Decision Timeframe Decision made during phone screening
Medication
  • Amount/Supply Not applicable
  • Sent To Varies
  • Delivery Time ID number given over the phone or card shipped within 7-10 business days
  • Refill Proces Not applicable
  • Limit Up to one year
  • Re-application Must re-enroll at end of calendar year
Additional Information
Eligible patients may be able to save up to $7,500 per year with no monthly limit. Patient Assistance Program also available; Contact program for details.
Updated September 26, 2018

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Patient Access Network Foundation (PAN)

(Program 3 of 3 — Scroll down to see them all )

Provided by: Patient Access Network Foundation
None
TEL: 866-316-7263
FAX: 866-316-7261
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Evotaz (atazanavir sulfate/cobicistat)
Eligibility Requirements
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must reside and receive treatment in US
Application
  • Obtaining Call or complete online
  • Receiving Complete online or by phone
  • Returning Complete online or by phone
  • Doctor's Action Will be discussed with patient and Doctor after request is received
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within 48 hours
Medication
  • Amount/Supply Not applicable
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Once approved; shipped same day
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit None
  • Re-application New application every 12 months
Additional Information
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Updated July 10, 2018

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