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GlaxoSmithKline Commitment to Access
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PO Box 29038
Phoenix, AZ 85038-9038
Phone
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866-265-6491
Fax:
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Eligibility
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The patient must have no prescription coverage for the requested medication and have an income at or below 350% of the Federal Poverty Level. The patient must also be a US resident. |
| Who Can Apply
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The patient advocate can call for an application or start the application process on line. |
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Required
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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. |
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Supply
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Up to a 30-day supply |
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Ship To
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Doctor's office |
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Note
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The patient advocate can call for an application or start the application process on line. |
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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.
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| Arranon Injection |
| Bexxar Injection |
| Hycamtin Injection |
| Leukeran Tablets |
| Myleran Tablets |
| Tabloid Tablet |
| Tykerb |
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