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:
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Eligibility To qualify for the GSK Patient Assistance Program for Vaccines, you must:
- Have no third party coverage for Vaccines
- 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
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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 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.
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For Healthcare Providers - Prior to enrolling patients, prescribers must register in the program.
- For patient enrollment, prescribers may fax the completed and signed application to 1-855-474-3063 or submit through the provider portal via GSK Patient Assistance Program Portal. Once approved, the applicant will be eligible to received vaccine for up to one year.
- Once enrolled, the patient may 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:
