SPRYCEL® (dasatinib) Patient Assistance: Ship-to-Patient Option
Bristol-Myers Squibb is pleased to offer the Ship-to-Patient Option to patients who are enrolled in the SPRYCEL Patient Assistance Program, and whose healthcare providers consent to having SPRYCEL shipped directly to the patient’s home. Complete prescription orders that are received by 10:45 AM Eastern Time are shipped the next day.
Upon enrollment, the patient’s healthcare provider can chose to have a patient’s medication shipped directly to them. The healthcare provider has the abilty to change the delivery instructions each time the medication is refilled.
A change of address can be recorded on the medication refill form or processed by calling Destination Access. Patients or their healthcare providers may also call to check the status of their shipment, regardless of the shipment destination.
Participants in the SPRYCEL Patient Assistance Program must reapply on the anniversary of their first filled prescription; Program eligibility must be renewed annually. Download a SPRYCEL Patient Assistance Program enrollment form.
If the patient already participates in the Ship-to-Patient Option, the office may download a SPRYCEL refill form.
The patient and healthcare provider must complete the SPRYCEL enrollment form or the SPRYCEL refill form provided in the links below. In addition, the information can be typed directly into the forms provided in the links below, saved to the desktop, printed, and signed by the prescriber and the patient. The required forms should be faxed to Destination Access for processing. An application or refill form may also be obtained by calling Destination Access at 1-800-861-0048, Monday through Friday, 8:00 AM to 8:00 PM Eastern Time.
Download a SPRYCEL Patient Assistance Program enrollment form 
Download a SPRYCEL refill form
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