Enrollment options to support you and your patient

Enrollment options to support you and your patient

BMS Access Support® offers both online and fax enrollment.

Start here to conduct a benefits review, initiate assistance with prior authorizations and appeals, and request financial support program enrollment for eligible patients. Once the enrollment form has been submitted and a benefits review has been conducted, you will receive your patient’s summary of healthcare benefits.

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Online Enrollment

Online Enrollment

Select the appropriate medication below to begin online enrollment. Once you complete your portion of the enrollment form, your patient will receive an email prompting them to complete and sign their portion of the form. Enrollment is not complete until the patient form has been completed and signed.

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Fax Enrollment

Fax Enrollment

If you prefer to manually complete the enrollment process, please download the appropriate enrollment form below based on the product your patient has been prescribed and fax the completed form to the number listed on the form.

Download form for:

AUGTYRO™ (repotrectinib)

EMPLICITI® (elotuzumab)

OPDIVO® (nivolumab) and OPDIVO Combination

OPDUALAG (nivolumab and relatlimab-rmbw)

SPRYCEL® (dasatinib)

YERVOY® (ipilimumab)

Download form for:

ABRAXANE® (paclitaxel protein-bound particles for injectable suspension) (albumin-bound)

IDHIFA® (enasidenib)

INREBIC® (fedratinib)


ONUREG® (azacitidine)

POMALYST® (pomalidomide)

REBLOZYL® (luspatercept-aamt)

REVLIMID® (lenalidomide)

THALOMID® (thalidomide)


Download form for:

NULOJIX® (belatacept)

Note, a completed form requires signatures from both physician AND patient. Completed forms should be faxed to the number provided on the form.

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If your office prefers to complete enrollment manually via fax but your patient is not present, patients can sign their Patient Authorization and Agreement form electronically. Visit the patient e-signature portal.