Nulojix Patient Assistance Programs

Nulojix: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Nulojix. 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?

BMS Access Support Kidney Transplant Support

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

Provided by: Bristol-Myers Squibb Company
Kidney Transplant Reimbursement Support PO Box 221509 Charlotte, NC 28222-1509
TEL: 800-861-0048
FAX: 888-776-2370
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Nulojix (belatacept)
Eligibility Requirements
  • Insurance Status Must be commercially insured
  • Those with Part D Elibible? No
  • Income Not applicable
  • Diagnosis/Medical Criteria Must be 18 yr old or older
  • U.S. Residency Required? Must be residing in the US or Puerto Rico
Application
  • Obtaining Call or download
  • Receiving Downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section and sign
  • Decision Communicated Doctor notified
  • Decision Timeframe 2 business days, once application process is complete
Medication
  • Amount/Supply Contact the program for more details.
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Up to two years
  • Re-application Must re-enroll at end of calendar year
Additional Information
None
Updated October 5, 2018

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