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Patient Assistance Information

 
2 Programs for Wellbutrin XL Tablets
 
 
GlaxoSmithKline Bridges to Access Program

PO Box 29038,Phoenix, AZ 85038-9038
Phoenix, AZ 85038-9038
Phone : 866-728-4368
Fax:
Eligibility
> The patient must have no prescription coverage for the requested medication and have an income at or below 250% of the Federal Poverty Level. The patient must also be a US resident.
Who Can Apply
> The patient advocate can call for an application or start the application process on line.
Required
> The doctor must fill out a section, sign the application and attach a prescription.The patient must fill out a section, sign the application, and attach proof of income and any denial letters from insurance companies.
Supply
>
Ship To
> Patient's home advocate
Note
> The patient advocate can call for an application or start the application process on line.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Wellbutrin XL Tablets
 
 
 
GSK Access

PO Box 52046
Phoenix, AZ 85072-2046
Phone : 866-518-4357
Fax:
Eligibility
> The patient must have Medicare Part D, and have an income at or below 250% of the Federal Poverty Level.
Who Can Apply
> Anyone requesting assistance can call to request a faxed application or download it from the website.
Required
> The patient must fill out a section, sign the application and attach proof of income and any insurance information.
Supply
> Pharmacy card
Ship To
> Patient's home
Note
> Anyone requesting assistance can call to request a faxed application or download it from the website.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Wellbutrin XL Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader