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Patient Assistance Information

 
 
 
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.
 
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