Zejula Copay Program Terms & Conditions

For information on Zejula Copay Program, please call 1-844-283-7276 or 1-844-4GSK-ONC (1-844-475-4662) or visit TogetherwithGSKOncology.com.

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

Zejula Full Terms and 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 may be eligible for the Together with GSK Oncology Commercial Co-pay Program, you and your patient must submit an Enrollment Form or you can complete and submit information online at www.CopayApplication.com, signature is required to complete the eligibility check. The Together with GSK Oncology Commercial Copay Program will evaluate the patient for eligibility and communicate eligibility to you and to the patient. Eligibility in the Together with GSK Oncology Commercial 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 Together with GSK Oncology HUB.


Patients who 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 Together with GSK Oncology Commercial Co-Pay Program. Medicare eligible patients who are enrolled in a government subsidized retiree prescription drug benefit plan or an employer group waiver health plan are also ineligible for the Co-pay program. (Most patients become eligible for Medicare when they reach age 65).


The Together with GSK Oncology Commercial 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 a GSK Oncology product in order to apply for the Commercial 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 Together with GSK Oncology Commercial Co-pay Program, your patient is not eligible to participate.


Program Details:

If your patient is approved, the Together with GSK Oncology Commercial Co-pay Program may help with the patient's cost share for a GSK Oncology product and the cost of administration, up to $100 per administration for IV products, up to a program total of $26,000 annually. Residents of Massachusetts, Michigan, Minnesota or Rhode Island, are not eligible for reimbursement of administration fees. Doctor's office visits, labs, and other ancillary services are not included in the Co-Pay Program.


Your patient should inform Program representatives of any changes in insurance coverage during the course of enrollment in the Together with GSK Oncology Commercial Co-pay Program. Please note that after 90 days of non-use of an approved and/or activated Together with GSK Oncology Commercial 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 Together with GSK Oncology Commercial Co-pay Card.