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GlaxoSmithKline Bridges to Access Program
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PO Box 29038,Phoenix, AZ 85038-9038
Phoenix, AZ 85038-9038
Phone
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866-728-4368
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 250% 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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Ship To
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Patient's home advocate |
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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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| Advair Diskus Inhalation Powder |
| Advair HFA |
| Agenerase Capsules |
| Agenerase Oral Solution |
| Albenza Tablets |
| Altabax Ointment |
| Amerge Tablets |
| Amoxil Capsules |
| Amoxil Oral Solution |
| Amoxil Powder for Oral Suspension |
| Amoxil Tablets |
| Amoxil Tablets - Chewable |
| Arixtra Injection |
| Augmentin |
| Augmentin ES Tablets |
| Augmentin ES-600 Powder for Oral Suspension |
| Augmentin Oral Solution |
| Augmentin powder for Oral Suspension |
| Augmentin Tablets |
| Augmentin Tablets - chewable |
| Augmentin XR Tablets |
| Avandamet Tablets |
| Avandaryl Tablets |
| Avandia Tablets |
| Avodart Soft Gelatin Capsules |
| Axid (nizatidine) |
| Bactroban Cream |
| Bactroban Ointment |
| Beconase AQ Nasal Spray |
| Bexxar Injection |
| Combivir Tablets |
| Coreg CR Tablets |
| Cutivate |
| Daraprim Tablets |
| Dyazide Capsules |
| Dynacirc CR Tablets |
| Epivir HBV Oral Suspension |
| Epivir Oral Suspension |
| Epivir Tablets |
| Epivir-HBV Oral Solution |
| Epivir-HBV Tablets |
| Epzicom Tablets |
| Flovent Aerosal Spray |
| Flovent Inhaler |
| Flovent Rotadisk |
| Fortaz Injection |
| Imitrex Injection |
| Imitrex Nasal Spray |
| Imitrex Tablets |
| InnoPran XL |
| Lamictal Tablets |
| Lamictal Tablets - Chewable |
| Lanoxicaps Capsules |
| Lanoxin Pediatic Elixer |
| Lanoxin Pediatric elixer |
| Lexiva Tablets |
| Lotronex Tablets |
| Lovaza Capsules |
| Malarone Pediatric Tablets |
| Malarone Tablets |
| Mepron Suspension |
| Parnate Tablets |
| Paxil CR Tablets |
| Paxil Oral Suspension |
| Paxil Tablets |
| Relenza (zanamavir) |
| Requip Tablets |
| Retrovir Capsules |
| Retrovir Syrup |
| Retrovir Tablets |
| Rythmol SR (propafenone HCl) |
| Rythmol SR Capsules |
| Serevent Diskus Powder for Inhalation |
| Timentin |
| Timentin Injection |
| Trizivir Tablets |
| Valtrex Capsules |
| Ventolin HFA Inhaler |
| Veramyst Nasal Spray |
| Vesicare Tablets |
| Wellbutrin SR (bupropion HCL) |
| Wellbutrin SR Tablets |
| Wellbutrin XL Tablets |
| Zantac Efferdose Tablets |
| Zantac Injection |
| Zantac Injection - premixed |
| Zantac Syrup |
| Ziagen Oral Solution |
| Ziagen Tablets |
| Zinacef Injection |
| Zofran Tablets-orally disintergrating |
| Zovirax Capsules |
| Zovirax Suspension |
| Zyban Sr Tablets |
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