Image of friends riding their bikes

GSK Patient Assistance Program for Vaccines

This section provides information about the GSK Patient Assistance Program for patients who need financial assistance with a GSK vaccine. This program does not constitute health insurance.

The following vaccines are currently included in the program:

  • BOOSTRIX (Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed)
  • ENGERIX-B [Hepatitis B Vaccine (Recombinant)]
  • SHINGRIX (Zoster Vaccine Recombinant, Adjuvanted)
  • Checklist icon Eligibility

    To qualify for the GSK Patient Assistance Program for Vaccines, you must:

    • Have no third party coverage for Vaccines OR be enrolled in a Medicare Part D Prescription Drug Plan and have spent at least $600 on prescription medicines through your Medicare Part D Prescription Drug Plan during this calendar year
    • Be an adult, 18 or older
    • Live in the United States or Puerto Rico
    • Not be eligible for Puerto Rico's Government Health Plan Mi Salud or have applied and been denied
    Image of son talking to his father

    You must also meet certain household income eligibility requirements as outlined below:

    48 States and DC
    Household Size Maximum Monthly Gross Income
    1  
    2  
    3  
    4  
    For each additional person, add  
    Calculate your monthly income limit if you have more than 4 people living in your household, including yourself.
     
    Alaska
    Household Size Maximum Monthly Gross Income
    1  
    2  
    3  
    4  
    For each additional person, add  
    Calculate your monthly income limit if you have more than 4 people living in your household, including yourself.
     
    Hawaii
    Household Size Maximum Monthly Gross Income
    1  
    2  
    3  
    4  
    For each additional person, add  
    Calculate your monthly income limit if you have more than 4 people living in your household, including yourself.
     
    Puerto Rico
    Household Size Maximum Monthly Gross Income
    1  
    2  
    3  
    4  
    For each additional person, add  
    Calculate your monthly income limit if you have more than 4 people living in your household, including yourself.
     
  • Enrollment icon Enrollment

    You must enroll in the GSK Patient Assistance Program through your healthcare provider

    • Your healthcare provider will need to first register with the program. Your healthcare provider will submit your application.

    Assistance is available in Spanish and many other languages: 1-866-728-4368

    La asistencia está disponible en español y muchos otros idiomas: 1-866-728-4368

  • HCP icon For Healthcare Providers

    • Prior to enrolling patients, prescribers must register in the program.
    • For patient enrollment, prescribers must fax the completed and signed application to 1‑855‑474‑3063. Once approved, the applicant will be eligible to receive vaccine for up to one year.
    • Once enrolled, the patient can receive subsequent doses of vaccine by having the prescriber complete the Dose Authorization Request Form.

    Updated Application Forms Now Available

    You may call 1-866-728-4368 to request an application by mail, or download a program application here: