Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 1 of 2   Scroll down to see them all.  Updated May 02, 2013 Back | Print Page

This program provides brand name medications at no or low cost.

Bridges to Access

Provided by:


GlaxoSmithKline
PO Box 29038
Phoenix, AZ 85038-9038

TEL: 866-728-4368


ALT PHONE:
FAX: 1-855-474-3063
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Avandamet Tablet 2mg/500mg, 4mg/500mg, 2mg/1000mg, 4mg/1000mg (metaformin/rosiglitazone)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? No
Income At or below 250% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Yes
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail from Doctor's office or advocate
Doctor's Action Fax in prescription
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient notified in writing
Decision Timeframe Within 2-3 days
Amount/Supply Up to 90 day supply
Sent To Patient's home, doctor's office, hospital or pharmacy
Delivery Time Not specified
Refill Process Patient must contact company
Limit Not specified
Re-application New application yearly

Additional Information:

Prescription must come directly from the doctor’s office

Patients may apply on their own. Advocates must call to enroll Bridges to Access applicants who need immediate access to medicine (please see web page http://www.bridgestoaccess.com/ for further details about the two methods of enrollment).
The application can be filled out and printed from the website, but each application need an individual number (which the website does automatically.)
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 2.  Updated May 02, 2013 Back | Print Page

This program provides brand name medications at no or low cost.

GSK Access

Provided by:


GlaxoSmithKline
PO Box 52046
Phoenix, AZ 85072-2046

TEL: 866-518-4357


ALT PHONE:
FAX: 866-518-3994
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Avandamet Tablet  (rosiglitazone maleate/metformin HCI)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have Medicare Part D
Those with Part D Eligible? Yes, with proof of spending $600 on prescription drugs in current calendar year
Income At or below 250% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside in the US
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach proof of income and any insurance information
Decision Communicated Patient notified in writing
Decision Timeframe Within 2-3 days
Amount/Supply Up to 90 day supply
Sent To Patient's home
Delivery Time Not specified
Refill Process Patient must contact company
Limit Not specified
Re-application New application yearly

Additional Information:




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