Commitment to Access Supports Patients Prescribed Arzerra, Other Medications

GlaxoSmithKline (GSK) offers support programs to patients with cancer in the United States or Puerto Rico. Through its Commitment to Access program, patients prescribed GSK medications potentially have access to free medicine, reimbursement support, or copay assistance. The programs differ in structure for federally insured, privately insured, and uninsured patients. For a complete list of oncology and oncology-supportive drugs covered through these programs as well as their indications, see the Table. For more information, visit www.gskcta.com or call 866-265-6491.

Eligibility Criteria
Patients with a household income of ≤500% of the federal poverty level (FPL) may qualify for the following programs if other criteria are met:

• Patient Assistance. GSK offers cancer medicines free of charge to eligible patients in the United States and Puerto Rico who meet income and other eligibility criteria. Candidates cannot be eligible for Medi­caid or Puerto Rico’s Government Health Plan or have coverage for brand name prescription drug benefits. Patients under Medicare Part D who spend ≥$600 on prescription medicines during the current calendar year are eligible to enroll.
• Reimbursement Support. Patients who have private prescription drug coverage, and are in a health plan that permits member participation in copay assistance programs may be eligible if other criteria are met. Financial assistance will vary depending on the FPL percentage range at time of enrollment and specific commercial insurance coverage.
• Copayment Assistance. This program is available to patients with commercial insurance coverage, including those who are enrolled in a Health Insurance Marketplace plan or exchange. GSK will determine eligibility and proportion of coverage based on income.

What Patients Will Receive

• All medicines are mailed to the prescriber or directly to the patient’s home based on program guidelines per medication.
• In order to receive the medicine by mail, send in the application, income documentation, and a prescription for the requested medicine to GSK.

How to Obtain Refills

• Call 866-265-6491 (8ON-COL-OGY1).
• Order refills ≥2 weeks before the patient runs out of medicine or 7 to 10 days before the next treatment.
• Refills are sent at no cost for up -to 12 months after enrollment in Commitment to Access. (Refills for eligible Medicare Part D patients are sent through the end of the current calendar year.)
• Refills can be sent to the prescriber’s office or directly to the patient’s home based on program guidelines per medication.

Enrollment
An enrollment form is available at www.gskcta.com/enrollment/phoneapplication.html. Applications must be faxed to 800-750-9832 from a prescriber’s facility or mailed to the program’s PO Box. Prescriptions must be submitted for processing with the enrollment form; up to 13 refills, if medically appropriate, can be requested at the time the prescription is submitted.

A patient who is enrolling for the first time for Patient Assistance must also register a healthcare worker involved in the patient’s care as his or her patient advocate.