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

Program 1 of 1.  Updated May 15, 2013 Back | Print Page

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

GSK Vaccines Access Program

Provided by:


GlaxoSmithKline


TEL: 877-822-2911


ALT PHONE:
FAX: 877-822-1555
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Cervarix Vaccine  (human papillomavirus (types 16, 18), recombinant, adjuvanted)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no health insurance for vaccine
Those with Part D Eligible? No
Income At or below 250% of FPL
Diagnosis/Medical Criteria Must be 19 yr old or older
US Residency Required? Must reside in the US
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Register with program, complete sections, obtain patients completed application with income documentation
Applicant's Action Provide prescriber signed application and income documentation
Decision Communicated Health care provider notified via fax
Decision Timeframe Usually same day
Amount/Supply Varies
Sent To Doctor's office
Delivery Time Not applicable
Refill Process Doctor/Doctor's office must complete replacement form
Limit Not specified
Re-application New application, new documentation yearly

Additional Information:

For the Cervarix vaccine, women need to be between 19-25 years old.



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