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)

(Program 1 of 2 — 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 Contact program for details.
  • Those with Part D Elibible? Contact program for details.
  • Income Not disclosed
  • Diagnosis/Medical Criteria Varies
  • 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, sign, attach required documents
  • 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 Varies
  • Delivery Time Not specified
  • Refill Proces Contact program for details.
  • Limit Varies
  • Re-application Must re-enroll at end of calendar year
Additional Information
This program also provides copay assistance.
Updated January 11, 2019

Back to top

Bristol-Myers Squibb Patient Assistance Foundation

(Program 2 of 2 — 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
  • Nulojix (belatacept)
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
None
Updated January 8, 2019

Back to top