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Patient Assistance Information

 
4 Programs for Advair Diskus Inhalation Powder
 
 
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
 
 
 
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.
 
Advair Diskus Inhalation Powder
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
Orange Card

Orange Card
,
Phone : (888) 672-6436
Fax:
Eligibility
> 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.
Who Can Apply
> Patient should call for application.
Required
> Minimal information is required.
Supply
>
Ship To
>
Note
> 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.
 
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
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
Together Rx Access

PO Box 9426
Wilmington, DE 19809-9944
Phone : 800-444-4106
Fax:
Eligibility
> The patient must have no insurance and have an income at or below $30,000 for an individual ($60,000 for a family of four) The patient must also be a US resident.
Who Can Apply
> The patient can call to get an application, apply on line, or download the application.
Required
> Eligible people simply respond to four questions to enroll.
Supply
> Together Rx Access prescription savings card.
Ship To
> Patient's home
Note
> The patient can call to get an application, apply on line, or download the application.
 
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
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader