GSK Co-pay Program Terms & Conditions

For information on Benlysta Co-pay Assistance Program, please call 1-877-423-6597 or visit BenlystaCoPayProgram.com.

For information on Nucala Co-pay Assistance Program, please call 1-844-468-2252 or visit NucalaCoPayProgram.com.

Assistance is available in Spanish and many other languages
La asistencia está disponible en español y muchos otros idiomas

Full Terms & Conditions

Eligibility criteria

Your patients may be eligible based on general eligibility criteria below:

  • Have a commercial medical or prescription insurance plan; or
  • Are uninsured;
  • AND
  • Are a resident of the US (including the District of Columbia, Puerto Rico, and the US Virgin Islands); and
  • Are not eligible for or enrolled in a government funded programs

To determine if your patient is eligible for the [BENLYSTA or NUCALA] (herein "GSK") Co-pay Program, you and your patient must submit a Service Request form. The Gateway will evaluate the patient for eligibility and communicate eligibility to you and to the patient. Eligibility in the GSK Co-pay Program is for one year. Patients must apply for Co-pay assistance each year that they wish to participate in the Program. Final patient eligibility determinations are provided by the GSK Gateway.

Patients who are eligible for Medicare and/or have insurance coverage provided through any type of state-, federal-, or government funded program (e.g., Medicare, Medicaid, Tricare, VA) are not eligible to participate in the GSK Co-Pay Program. For purposes of GSK's Co-pay Program, if you are age 65 or older you are not eligible to participate in this Co-pay Program because you are deemed to be eligible for Medicare.

The GSK Co-pay Program is not insurance. GSK reserves the right to rescind, revoke, or amend this offer without notice at any time. Offer good only in the United States (including the District of Columbia, Puerto Rico and the US Virgin Islands). Void where prohibited, taxed, or otherwise restricted by law.

Your patient must have a prescription for the GSK Product in order to apply for the GSK Co-pay Program. If your patient's prescription drug coverage is provided by a private commercial payer and the commercial payer has opted out of the GSK Co-pay Program, your patient is not eligible to participate.

Program Details:

If your patient is approved, the GSK Co-pay Program may help with the patient's cost share for the GSK product, up to a total of $11,000 annually and the cost of administration, up to $100 per administration with a maximum benefit of $3,900 annually. Residents of Massachusetts, Michigan, Minnesota or Rhode Island, are not eligible for reimbursement of administrative fees. Doctor's office visits, labs, and other ancillary services are not eligible for reimbursement. Patients are required to pay the cost of administration fees out of pocket and then utilize the Co-Pay & Administration Fee Reimbursement Request Form to request reimbursement via check through the Program. Patients have 180 days from the date of service to submit documents listed above to obtain reimbursement.

Your patient should inform Program representatives of any changes in insurance coverage during the course of enrollment in the GSK Co-pay Program. Please note that after 90 days of non-use of an approved and/or activated GSK Co-pay Card, funding will be released back to the Program. If the patient is still receiving the product, the patient may contact the Program and request that funds be reloaded onto the GSK Co-pay Card.