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These programs are for patients who have been prescribed a Bristol Myers Squibb CAR T cell therapy. Both the patient and a treating healthcare provider from the certified treatment center are needed to complete the form.
For patients to receive an enrollment form, it is recommended that they talk to their treating healthcare provider. For healthcare providers at certified treatment centers, the enrollment form can be received by contacting their dedicated cell therapy account manager, calling 1-888-805-4555, or accessing the Cell Therapy 360 Scheduling Portal.
Have a completed enrollment form you need to submit? Upload and submit it, along with copies of the front and back of the patient’s insurance card, below or fax the completed form to 1-866-588-6829.
CAR=chimeric antigen receptor.
You are now entering the Cell Therapy 360® Scheduling and Apheresis Portal.
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This internet site may provide links or references to other sites. BMS has no responsibility for the content of such other sites and is not liable for any damages or injury arising from that content. Any links to other sites are provided merely as a convenience to the users of this internet site.
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Your work will not be saved until you fill out the Patient Authorization and Consent page and submit your part of the enrollment form.
It won’t take long!
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Please confirm your patient’s diagnosis:
Please confirm that you are a:
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Select a disease state:
R/R=relapsed/refractory.
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Insurance coverage information is currently available for R/R large B-cell lymphoma only.
R/R=relapsed/refractory.
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Please confirm your patient’s diagnosis:
R/R=relapsed/refractory.