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Orange Card
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Orange Card
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Phone
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(888) 672-6436
Fax:
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Eligibility
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Seniors age 65 and older and the disabled enrolled in Medicare with annual income below $30,000 single/$40,000 couple (approximately 300% of poverty) and patient must not have public or private insurance coverage for prescription medicines.
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Who Can Apply
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Patient should call for application. |
Required
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Minimal information is required. |
Supply
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Ship To
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Note
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Discounts are 25% off the wholesale list price of GlaxoSmithKline outpatient drugs. Participating pharmacies charge card holders no more than a negotiated price. GlaxoSmithKline expects card holders to realize average savings of 30-40% off retail prices.
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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. |
Advair Diskus Inhalation Powder |
Agenerase Capsules |
Amerge Tablets |
Amoxil Capsules |
Augmentin Oral Solution |
Avandemet |
Avandia Tablets |
Avodart Soft Gelatin Capsules |
Bactroban Cream |
Beconase AQ Nasal Spray |
Combivir Tablets |
Daraprim Tablets |
Dyazide (Triamterene & Hydrochlorothiazide) |
Epivir Tablets |
Epivir-HBV Tablets |
EskalithCR (Lithium Carbonate) |
Flovent Inhaler |
Imitrex Tablets |
Lamictal Tablets |
Lanoxicaps Capsules |
Leukeran Tablets |
Lexiva Tablets |
Malarone Tablets |
Mepron Suspension |
Myleran Tablets |
Parnate Tablets |
Paxil (paroxetine HCL) |
Relafen (nabumetone) |
Relenza (zanamavir) |
Requip Tablets |
Retrovir Tablets |
Serevent Diskus Powder for Inhalation |
Stelazine (Trifluoperazine HCl) |
Tabloid Tablet |
Thorazine (chlorpromazine) |
Trizivir Tablets |
Valtrex Capsules |
Wellbutrin SR (bupropion HCL) |
Ziagen Tablets |
Zinacef Injection |
Zyban Sr Tablets |
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Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form Application Form |
(Requires Acrobat Reader)
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