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

GSK Vaccines Access Program

Provided by: GlaxoSmithKline


TEL: Closed Program


Languages Spoken:

English, Spanish, Others By Translation Service

 

Patient Assistance Applications

 

Generic Name Medications Covered

 
 

Eligibility Requirements   

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 live in US or DC
   

Application

Obtaining Call
Receiving Faxed or mailed
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 Within 1-2 business days
   

Medication

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

Closed Program

This program does not constitute health insurance.


Updated November 14, 2017