![]() ![]() This is also known as the Prepaid Medical Assistance Program. NOTE: Linked drugs are available for Prescribers to Apply Online now.Ĭlick drug logo or drug name to start online application.Īpplications that patients can fill out and bring to their doctor. You must be enrolled in a Medicare prescription drug plan to get prescription drug benefits. Copayments for the medications on this list, whether made by you, your plan or a manufacturers copay assistance program, will not count toward your plan. This program also provides copay assistance. Live in the United States or Puerto Rico (or the US Virgin Islands for certain medicines) The last date to submit a new application for ADVAIR DISKUS, ADVAIR HFA, and BECONASE AQ is. This program can help you receive certain GSK prescription medicines at no cost. Doctor and Patient must complete and sign application.Īmount/supply not specified. GSK Patient Assistance Program for Prescription Medicines. Medically appropriate condition/diagnosis required. Must reside in the US, DC, Puerto Rico or the USVI.Ĭall to have application faxed or mailed or download. ![]() Medicare Part D patients are not eligible for this program. This program is intended for patients that have insurance.
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