For Referring Healthcare Providers

Manage your referrals and track patients receiving Bristol Myers Squibb CAR T cell therapy through the Referral Dashboard.

The decision to refer a patient, and the selection of a particular certified CAR T cell therapy treatment center, is made solely by the referring provider and the patient. It is the referring provider’s responsibility to follow all legal and institution requirements for such referrals. Only a certified CAR T cell therapy treatment center can decide if CAR T cell therapy is the appropriate treatment choice for a patient.

Referral Request

  • Step 1 Patient Consent Start with a signed patient consent form.
  • Step 2 Physician Details Tell us about yourself to start this referral.
  • Step 3 Patient Details Tell us about your patient.
  • Step 4 Treatment Center Search and select up to 3 treatment center locations.
  • Step 5 Benefits Investigation and
    Consultation Support Cell Therapy 360 can perform a benefits investigation request within 48 hours and assist your patient in scheduling a consultation with the treatment center selected to help avoid access hurdles if initiating treatment.

Physician details:

Healthcare team details:

Submitting a referral on a physician’s behalf? Please provide your details below. If not, please continue ahead.

CAR=chimeric antigen receptor.

Patient details:

Gender:
Confirm diagnosis:

CAR=chimeric antigen receptor; R/R=relapsed/refractory.

Search CAR T cell therapy treatment centers. Add up to 3 locations, in the order of your patient’s preference.

0/3 selected

Location 1 00 First Street
Phoenix, AZ 85054
Add

CAR=chimeric antigen receptor.

Benefits Investigation
Understanding their CAR T cell therapy insurance coverage can help provide important information to your patient before their CAR T cell therapy consultation.

We’ll look into potential coverage and copay details—results are typically available within 24-48 hours. The final benefits determination will be performed by the CAR T cell therapy treatment center.

Consultation Support
A Cell Therapy 360® Patient Support Navigator can contact your patient directly and assist with scheduling a CAR T cell therapy consultation with their treatment center of choice.

To Note: The Cell Therapy 360 Patient Support Navigator will only assist with scheduling a CAR T cell therapy consultation. No additional patient support is offered as part of the referral process.


To continue, make a selection for your patient:

Patient contact

Primary insurance

Please provide your patient’s insurance information by either uploading images of the front and back of your patient’s insurance card or filling out the form below.

For questions about insurance or if your patient does not have insurance, call 1-888-805-4555 for assistance.

Upload a copy of your patient’s insurance card (photo or scan)

Card Front

Card Back

Cancel

OR

Fill out the following form:

Add secondary insurance Remove secondary insurance

Secondary insurance

CAR=chimeric antigen receptor.

Final Review

  • Patient Consent
  • Physician Details
  • Patient Details
  • Treatment Center
  • Benefits Investigation
  • Consultation Support

Your referral is ready to send.

Submit

BMS values your privacy. BMS, its affiliates, and its agents will not sell or rent your personal information. By providing your information, you acknowledge that you have read and agree to BMS’s Privacy Policy.

CAR=chimeric antigen receptor.

Referral Sent! Thank you.

Please download a copy of the completed referral form for your records.

Download the completed referral form

CAR=chimeric antigen receptor.

The decision to refer a patient, and the selection of a particular certified CAR T cell therapy treatment center, is made solely by the referring provider and the patient. It is the referring provider’s responsibility to follow all legal and institution requirements for such referrals. Only a certified CAR T cell therapy treatment center can decide if CAR T cell therapy is the appropriate treatment choice for a patient.