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eliquis patient assistance form

by Prof. Julianne Rolfson Published 1 year ago Updated 1 year ago
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How do I get a prescription for Eliquis?

or complete the online form at: www.bms.com/dpo/us/request Click here for U.S. Full Prescribing Information, including Boxed WARNINGSand Medication Guide, or visit ELIQUIS.com. The patient or his/her representative must be provided with a copy of this Patient Authorization and Agreement Form after it has been signed.

Is the co-pay card for Eliquis considered health insurance?

The Co-pay Card for ELIQUIS is not health insurance. The Co-pay Card will be accepted only at participating pharmacies. For those customers using mail order or any non-participating retail pharmacy, please call 866-279-4730 to request a patient rebate form, or go to www.patientrebateonline.comto download a form.

What is the patient support program for Eliquis® (apixaban)?

The patient support program for ELIQUIS®(apixaban) (the “Program”) is designed to provide you with reimbursement support services. To participate in the Program we will need to receive, use, and disclose your personal information. Please read this form carefully and contact Bristol Myers Squibb

How to edit Eliquis patient assistance form?

PDF editor permits you to help make changes to your Eliquis Patient Assistance Form from the internet connected gadget, personalize it based on your requirements, indicator this in electronic format and also disperse differently. Turn your records into enforceable documents by making and implementing your signature with one click.

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How do you qualify for free eliquis?

You may be eligible for the Free 30-Day Trial Offer for ELIQUIS® (apixaban) if:You have not previously filled a prescription for ELIQUIS;You have a valid 30-day prescription for ELIQUIS;You are being treated with ELIQUIS for an FDA-approved indication that an HCP has planned for more than 35 days of treatment;More items...

Does Bristol Myers Squibb have a patient assistance program?

The Bristol Myers Squibb Patient Assistance Foundation (BMSPAF) is an independent, charitable organization that helps eligible patients who need temporary help obtaining the medicines listed on this website.

How can I afford my eliquis?

Bristol-Myers Squibb also offers a patient assistance program that can help some people get Eliquis at little to no cost. However, you must meet eligibility requirements based on income and insurance. Most people without insurance or with limited income will qualify.

How do I contact eliquis?

For more information about how insurance covers ELIQUIS and co-pay assistance for eligible, commercially-insured patients, visit ELIQUIS patient support or call 855-354-7847.

Is Eliquis made by Pfizer?

Blood thinner Eliquis has been a major growth driver for Bristol-Myers Squibb and partner Pfizer, as well as the overall biopharma sector. Now, though, the blockbuster earner might face some cheaper company. The FDA approved the first two copycats to Eliquis, made by Mylan and Micro Labs, on Christmas Eve.

What pharmaceutical company manufactures Eliquis?

Bristol-Myers Squibb Co.Brand Name: Eliquis® Generic Name: apixaban Manufacturer: Bristol-Myers Squibb Co. with nonvalvular atrial fibrillation. completing 6-12 months of standard anticoagulation for venous thromboembolism).

Is Eliquis going generic in 2022?

As the original manufacturers, they own a patent that prevents generics from being introduced until the patent expires. That patent was extended from February 2023 to November 2026. Both drug makers say that's when generics can be made available.

How much is Eliquis at Walmart?

The cost of Eliquis is $695.91 for 60, 5MG Tablet, but you can use an Eliquis coupon below to pay $459.24 per 60, 5mg Tablet....Average 12 Month Prices for Eliquis.PharmacyEliquis Retail PriceEliquis SingleCare PriceWalmart$601.08$528.01Walgreens$623.72$537.78Kroger Pharmacy$624.91$487.613 more rows

How do seniors pay for Eliquis?

Medicare typically covers Eliquis through Medicare Advantage Part C or Medicare Part D prescription drug coverage plans. Eliquis is a brand name for apixaban, a prescription oral anticoagulant tablet.

What is the cost of Eliquis?

The list price for a 30-day supply of ELIQUIS is $529. On average, patients pay $46 per month, and 5 out of 10 ELIQUIS patients pay $25 or less.

What foods should I avoid while taking Eliquis?

2 foods to avoid with blood thinnersLimit caffeine. There is no direct interaction between Eliquis and caffeine. ... High-fat foods. A diet high in saturated fats, red meat, and fast foods tend to promote fatty plaques in your blood vessels, which can increase the risk of heart disease and stroke.

Is there a generic brand of Eliquis?

Apixaban is the generic of Bristol Myers-Squibbs' Eliquis. It was developed by Towa Pharmaceutical Europe, in its manufacturing facility located in Martorelles, Spain. Eliquis had a market value of $14 billion during the 12 months ended May 2021, according to industry data.

What is simple fill?

Simplefill is a full-service prescription assistance company that is dedicated to making. prescribed medications affordable for our members. ARE YOU... one of the millions. of Americans who.

Does Walgreens accept eliquis co pay card?

Valid at all major chains including Walgreens, CVS Pharmacy, Target, WalMart Pharmacy, Duane Reade and 65,000 pharmacies nationwide.

How do I contact Bristol Myers Squibb?

Contact UsCustomer and Community Relations. 1-800-332-2056. (toll free U.S. only)Report Side Effects or Product Quality Complaints. 1-800-721-5072. (toll free U.S. only)Medical Information Contact Center. 1-800-321-1335. (toll free U.S. only) Mon - Fri 8am - 8pm ET.

Who makes Januvia?

Januvia's manufacturer, Merck, offers a program to help reduce your out-of-pocket costs to as little as $5 per month.

What is Eliquis used for?

ELIQUIS is indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). ELIQUIS is indicated for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery.

How much does Eliquis cost?

Eligible patients who present an activated Co-pay Card together with a valid prescription for ELIQUIS at participating pharmacies may pay as little as $10 per 30-day supply (up to 74 tablets for the first fill and up to 60 tablets for all subsequent fills) for up to 24 months, subject to a maximum annual benefit of $3800. Other restrictions may apply. Patient is responsible for applicable taxes, if any.

How long is the Eliquis trial?

You may be eligible for the Free 30-Day Trial Offer for ELIQUIS®(apixaban) if: You have not previously filled a prescription for ELIQUIS; You have a valid 30-day prescription for ELIQUIS; You are being treated with ELIQUIS for an FDA-approved indication that an HCP has planned for more than 35 days of treatment;

How long after a catheter removal can you give Eliquis?

The next dose of ELIQUIS should not be administered earlier than 5 hours after the removal of the catheter. The risk may also be increased by traumatic or repeated epidural or spinal puncture. If traumatic puncture occurs, delay the administration of ELIQUIS for 48 hours.

Is Eliquis a copay?

The Co-pay Card for ELIQUIS is not health insurance.

How to contact McKesson Pharmacy?

To the pharmacist:For processing assistance, please call McKesson Pharmacy Support at 1-866-279-4730.

How long is the free trial for a new patient?

Free 30-day trial offer for first-time patients and

Available medicines

Find out if the medicine your doctor prescribed is available through the Bristol Myers Squibb Patient Assistance Foundation.

Eligibility

Complete a brief assessment to see if you might be eligible for assistance.

How to apply

We'll need some information from both you and your doctor to process your application.

What is Eliquis used for?

ELIQUIS (apixaban) is a prescription medicine used to treat blood clots in the veins of your legs (deep vein thrombosis) or lungs (pulmonary embolism), and reduce the risk of them occurring again . ELIQUIS (apixaban) is a prescription medicine used to reduce the risk of forming a blood clot in the legs and lungs of people who have just had hip ...

What are the symptoms of eliquis?

or bleeding. Tell your doctor right away if you have any of these signs or symptoms (especially in your legs and feet) when taking ELIQUIS: Tingling. Numbness.

How many different tablets are there for Eliquis?

ELIQUIS is available in two different tablets. Your doctor or healthcare provider will determine what dose is right for you.

Can you refill Eliquis after knee replacement?

When leaving the hospital following hip or knee replacement, be sure that you will have ELIQUIS available to avoid missing any doses. ELIQUIS is available in two different tablets. Your doctor or healthcare provider will determine what dose is right for you.

Can Eliquis cause bleeding?

Bleeding. ELIQUIS can cause bleeding, which can be serious, and rarely may lead to death. This is because ELIQUIS is a blood thinner medicine that reduces blood clotting. While taking ELIQUIS, you may bruise more easily and it may take longer than usual for any bleeding to stop.

Can you stop Eliquis before surgery?

ELIQUIS may need to be stopped prior to surgery or a medical or dental procedure. Your doctor will tell you when you should stop taking ELIQUIS and when you may start taking it again. If you have to stop taking ELIQUIS, your doctor may prescribe another medicine to help prevent a blood clot from forming.

Can you breastfeed with Eliquis?

Tell your doctor if you are pregnant or breastfeeding, or planning to become pregnant or breastfeed. You and your doctor should decide if you will take ELIQUIS or breastfeed. You should not do both.

What is prior authorization for Eliquis?

Prior authorization: If your insurance plan needs prior authorization before approving coverage of ELIQUIS, live specialists can help coordinate the process among your doctors, insurer, and pharmacist, and get the paperwork submitted.

What is a formulary exception?

Formulary exception requests: A formulary is an insurance company’s list of covered medications. Some insurance plans may not cover ELIQUIS, or will ask that a formulary exception request be submitted. Our live specialists can provide general information regarding the exception process to help you and your healthcare prescriber. If your prescriber is unable to get ELIQUIS approved, and if you are eligible, we will refer you to other co-pay assistance programs or the patient assistance program.

Available medicines

Find out if the medicine your doctor prescribed is available through the Bristol Myers Squibb Patient Assistance Foundation.

Eligibility

Complete a brief assessment to see if you might be eligible for assistance.

How to apply

We'll need some information from both you and your doctor to process your application.

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