I have Medicare Prescription Coverage

This section provides information about Zejula and Blenrep patient assistance programs for patients with Medicare prescription coverage. This program does not constitute health insurance.

As a reminder, eligibility for the GSK Patient Assistance Programs is based on a calendar year like Medicare. Therefore, your enrollment in GSK PAP will expire on December 31 and you will not be able to use GSK PAP to obtain your medication until you qualify for the program and re-enroll in the new year. To qualify for GSK PAP next year, you will need to meet eligibility requirements, including having met the out of pocket spend for your program on or after January 1, 2020.

Do I Qualify?

Zejula and Blenrep Patient Assistance Programs

To qualify for the Zejula or Blenrep Patient Assistance Program, you must:

  • Live in one of the 50 states, District of Columbia, Puerto Rico or U.S. Virgin Islands
  • Have a Medicare prescription drug plan and proof of out of pocket prescription spend this calendar year that is 3% or more of total household income The 3% of total household income for out of pocket spend for prescription medications is for the applicant and may include all prescription medications.

    The following documents may be submitted to the program.
    • Your most recent Medicare PART D explanation of benefits (EOB) or summary statement.
    • Your most recent Medicare PART B Summary Notice (MSN) reflecting prescription medication expenses. paid during the current calendar year for office based administration showing amount you have paid
    • A pharmacy printout listing year-to-date prescription expenses paid by the applicant.
    • Pharmacy receipts or statements that clearly document the out of pocket cost and payment.
    • Medical Billing Statement verifying what the patient has paid in prescription expenses for office administered medications.
    (the program will calculate this for you)
  • Not be eligible for Puerto Rico's Government Health Plan Mi Salud, or have applied and been denied
  • Meet certain income eligibility requirements. Patients whose income exceeds program eligibility maximum will be provided the opportunity to demonstrate that their eligible medical expenses bring them within the income eligibility criteria (please contact program for details)
Maximum Monthly Gross Income
Household Size
48 states, D.C. and U.S. Virgin Islands
Alaska
Hawaii
Puerto Rico
1
$5,316.67
$6,645.83
$6,116.67
$4,000.00
2
$7,183.33
$8,979.17
$8,262.50
$5,000.00
3
$9,050.00
$11,312.50
$10,408.33
$6,000.00
4
$10,916.67
$13,645.83
$12,554.17
$7,000.00
For each additional person, add
$1,866.67
$2,333.33
$2,145.83
$1,000.00
Calculate your monthly income limit if you have more than 4 people in your household
  • For assistance with the Zejula or Blenrep Patient Assistance Program please call Together with GSK Oncology at 1‑844‑4GSK‑ONC (1‑844‑447‑5662)