I Don't Have Insurance

This section provides information about the GSK Patient Assistance Program for patients who do not have insurance. This program does not constitute health insurance.

Enrollment in the GSK Patient Assistance Program for a non-vaccine product:

Enroll By Fax or Mail

You can enroll yourself in the GSK Patient Assistance Program. Here's how it works:

1. Complete the Application

  • Complete, print, and sign the GSK Patient Assistance Program enrollment application.
  • For help completing the application, call the GSK Patient Assistance Program at 1‑866‑728‑4368.

2. Submit Your Paperwork to the GSK Patient Assistance Program

  • Fax or mail your completed and signed application and prescription(s) for your GlaxoSmithKline medicines to:
    The GSK Patient Assistance Program
    P.O. Box 220590
    Charlotte, NC 28222-0590
    Fax Number: 1‑855‑474‑3063
    (faxed prescriptions are only valid if they are faxed directly from a physician's office)
  • Once your application is received and processed, you will receive a letter that lets you know whether or not you have been enrolled in the GSK Patient Assistance Program
  • The first 90-day supply of your GlaxoSmithKline medicine(s) will automatically be shipped to the address provided on your application. (Some drugs are only available at a retail pharmacy. You will be notified if your prescription is only available at a retail pharmacy.)

Refills

  • Refills are sent at no cost for up to 12 months after your enrollment.
  • Refills can be ordered here or by calling 1‑866‑728‑4368. Each refill must be requested at least 3 weeks before your existing supply of medicine is completed.
  • The prescription number is required each time a refill is requested. The prescription number can be found on the packing slip that comes with each shipment.

Renewing a Prescription

  • A physician's office may fax the prescription to 1‑855‑474‑3063.
  • Faxed prescriptions are only valid if faxed directly from a physician's office.
  • Applicant's name and date of birth must be on each faxed page.

Enroll By Phone When Medicine is Needed Immediately

Patients who need medicine that same day should ask their Advocate (i.e. someone such as a healthcare worker, social worker, or case worker, who is involved in the delivery of their healthcare) to enroll them in the GSK Patient Assistance Program by phone.

1. Complete the Application

  • Complete, print, and sign the enrollment application. For help completing the application, call the GSK Patient Assistance Program at 1‑866‑728‑4368.

2. Select an Advocate to Enroll You

  • Select someone involved in your healthcare to enroll you. This person may be a health care worker, social worker, case worker, or anyone involved in the delivery of your healthcare. This person is your Advocate.
  • Review the completed application and documents with your Advocate.
  • Your Advocate will call 1‑866‑728‑4368 to find out if you are eligible to receive medicine.
  • During the enrollment phone call, your Advocate will be told whether or not you qualify for the program.
  • If eligible, you may pick up your medicine that day at any retail pharmacy with your prescription. In the meantime, your Advocate must either fax or mail your application and documentation to the GSK Patient Assistance Program after the enrollment phone call. Please note that faxed prescriptions are only valid if faxed directly from a physician's office.

What should I bring to the pharmacy?

  • GSK Patient Assistance Program retail pharmacy processing information, provided by your Advocate upon completion of successful enrollment phone call.
  • Prescription for up to a 30 day supply of medicine, if appropriate.
  • To order subsequent refills, have the prescription number ready and click here or call 1‑866‑728‑4368 at least 3 weeks before your existing supply of medicine is gone.

Refills

  • Refills are sent at no cost for up to 12 months after your enrollment.
  • Patients requiring prescription assistance past the initial 30-day period of the phone enrollment will receive refills for medicines through mail order when requested. Some medicines are only available at the pharmacy.
  • Refills can be ordered here or by calling 1‑866‑728‑4368. Each refill must be requested at least 3 weeks before your existing supply of medicine is completed.
  • The prescription number is required each time a refill is requested. The prescription number can be found on the packing slip that comes with each shipment.

Renewing a Prescription

  • A physician's office may fax the prescription to 1‑855‑474‑3063.
  • Faxed prescriptions are only valid if faxed directly from a physician's office.
  • Applicant's name and date of birth must be on each faxed page.

The Re-Enrollment Process

Patients need to re-apply to the GSK Patient Assistance Program every 12 months.

  • A re-enrollment application will be mailed to you or your Advocate when it is time to re-apply.
  • Fax or mail your completed re-enrollment form and documents to the GSK Patient Assistance Program. Faxed prescriptions are only valid if faxed directly from a physician's office. Applicant's name and date of birth must be on each faxed page.
  • If you are still eligible for continued assistance through the GSK Patient Assistance Program, your first refill will automatically be sent to the address provided on the application.
  • To order subsequent refills, have the prescription number ready and click here or call 1‑866‑728‑4368 at least 3 weeks before the patient's existing supply of medicine is gone.