Help for your patients with cancer

As a healthcare provider, a pharmacist, or an office manager, you know how important it is for your patients to receive the treatment they need. You likely also know how complex the health insurance system can be.

To help your patients find reimbursement support for and access to their oncology and specialty medications, GlaxoSmithKline (GSK) has developed the CARES by GSK^™ program. The CARES by GSK^™ program supports oncology and specialty medications from GSK.

Click on a link below to learn more about reimbursement and access through the CARES by GSK^™ program.

Reimbursement support, including verification of insurance coverage and benefits
Patient assistance programs, which provide free prescription medication and GSK Co-Pay Assistance for patients with income limitations.
Distribution and information about which specialty pharmacies can distribute a GSK oncology product
Downloadable program forms for CARES by GSK^™ and Commitment to Access
Resources for you and your patients, including information on additional reimbursement services

Reimbursement support

To help your patients better navigate the health insurance system, CARES by GSK^™ offers you and your enrolled patients a variety of reimbursement services, including:

Verification of benefits. Reimbursement counselors will verify coverage for patients with all types of insurance, including Medicare, Medicaid, private payers, Veterans Affairs/VHA, TRICARE, AIDS drug assistance programs, children’s health insurance programs, state elderly drug assistance programs, and other state and local payers
Prior authorization assistance. Counselors can help patients proactively overcome obstacles to accessing treatment by researching prior authorization requirements for payer-restricted drugs
Coding and billing assistance. Counselors are available to answer questions about HCPCS, CPT, and ICD-9-CM codes for all applicable oncology medications
Coverage analysis. Counselors can research and provide patients with detailed coverage information, including a co-pay forecast
Denied and underpaid claims assistance. Counselors can research denied and underpaid claims to confirm that the claims were processed appropriately
Case management. Counselors can research foundations and assess eligibility for GSK’s patient assistance programs
Researching specialty pharmacies. Counselors will research specialty pharmacies that offer low co-pays

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Patient assistance programs

GlaxoSmithKline (GSK) offers several patient assistance programs to support patients with income limitations. Patients may be eligible if they are uninsured (have no prescription drug benefits), underinsured (have only generic prescription coverage), or if they have commercial insurance but need co-pay assistance. Commitment to Access also offer support to Medicare patients.

Patients must meet income eligibility requirements to qualify to receive co-pay assistance or Commitment to Access support. Taking into account the size of the patient's family and state in which they live, their gross income must be within one of the ranges listed below. These are gross monthly incomes, meaning the amount the patient makes each month before taxes are taken out.

Income eligibility requirements for patients:

Puerto Rico applicants at or below 200% FPL are not eligible for the GSK Co-Pay Assistance Program and are referred to Puerto Rico’s Government Health Plan

All sources of the patient's gross monthly income will be considered when determining the relationship of the household's income to the Federal Poverty Level.

GSK Co-Pay Assistance

Some patients have prescription drug coverage but need additional payment assistance because of income limitations. CARES by GSK counselors will research and connect eligible patients to a GSK Co-Pay Assistance program.

Program offerings

GSK Co-Pay Assistance is available only for select prescriptions for oral medications.
Patients pay only the co-pay listed in the table below, as determined during enrollment. The specialty pharmacy^† will invoice and collect the remainder of the bill from GSK or the administrator
The specialty pharmacy will ship the medication directly to the patient’s home or healthcare provider's office

^†Only select specialty pharmacies participate in this program. Medications cannot be processed through a dispensing clinic, an inpatient pharmacy, or another non-specialty pharmacy.

Eligibility criteria

Patients are eligible if they:

Live in one of the 50 States, District of Columbia or Puerto Rico, excluding residents of Massachusetts
Have private prescription drug coverage

Patients are ineligible if they:

Come to the United States seeking healthcare and live outside the United States
Have insurance coverage through a government-funded program such as Medicare or Medicaid
Are enrolled in a health plan that prohibits participation in copay assistance programs

Income eligibility requirements

From the completed CARES by GSK enrollment form, which will include income documentation, a counselor will determine the patient’s financial eligibility. The GSK Co-Pay Assistance program operates on a sliding scale based on the patient’s income relative to the federal poverty level. Participation in the program is renewed every 12 months based on continued eligibility.

To qualify:

The patient’s monthly out-of-pocket expenses must exceed the patient responsibility amount listed in the table below. When the patient's copay or coinsurance exceeds 50%, The GSK co-pay assistance program will supplement any costs that exceeds this amount, up to a maximum equal to 50%.
All sources of the patient’s gross monthly income will be considered when determining the relationship of the household’s income to the federal poverty level

^aFor updated co-pay information, call 1-888-ONE-GSKCARES (1-888-663-4752).

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Commitment to Access

To support patients who have lower incomes and who do not have prescription coverage, GSK offers a patient assistance program called Commitment to Access. The program is designed to provide patients who have lower incomes--that is, up to 5 times the federal poverty level--with GSK oncology and specialty pharmacy medications free of charge.

Commitment to Access program eligibility

*For complete eligibility criteria, please visit www.CommitmentToAccess.com.

Some important points to note

Refill requests must be submitted 7 to 10 days before the patient needs the medication. Refills are not sent automatically
Medication will be sent directly to the patient’s home or to the provider’s office

Please note that enrollment in Commitment to Access requires a form different from the CARES by GSK enrollment form. Download and complete the Commitment to Access enrollment form. For questions about Commitment to Access, call 1-8ONCOLOGY1 (1-866-265-6491).

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Distribution

Once your patient is enrolled in the CARES by GSK^™ program, a counselor will research and work directly with one of the specialty pharmacies listed below to ship the medication either directly to your patient’s home (for oral medications) or to your office if needed (for intravenous medications):

Accredo Health Group, Inc.	CuraScript
Advanced Care Scripts	Diplomat
Aetna Specialty Pharmacy	ICORE
Apothecary Shops	MedfusionRx/Ascend
GreaterSacramento Specialty Pharmacy	OncologyRx Care Advantage
Biologics, Inc.	OncoMed
Bioscrip^®	Oncosource RX
Cigna Tel-Drug	Prescription Solutions
Commcare	RightSource Specialty Pharmacy
CVS-Caremark	US Bioservices
CarePlus	Walgreens Specialty Pharmacy
	Wellcare

This list may change without notice. Please check this site for updated information.

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Downloadable program forms

It is important to complete the appropriate form accurately so that your application can be processed quickly. To provide further assistance in expediting your patient’s enrollment, CARES by GSK^™ counselors will follow up promptly with you and your patient about missing information on the enrollment form.

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Resources

In addition to the CARES by GSK^™ program, many other resources may be helpful to you and your patients.

American Society of Clinical Oncology (ASCO)—An organization of oncology providers committed to advancing the education of oncologists and other oncology professionals.
Chronic Disease Fund—Provides financial assistance to patients with chronic or life-threatening diseases who have commercial insurance of Medicare Part D.
HealthWell Foundation—Assists patients who have insurance but who cannot pay for their treatments, office visits, or supplies.
National Comprehensive Cancer Network (NCCN)—An alliance of 21 of the world’s leading cancer centers, dedicated to improving the quality and effectiveness of care provided to patients with cancer.
National Organization of Rare Diseases (NORD)—A nonprofit organization that advocates for patients with rare diseases and works with the various organizations to enhance research, treatments, and cures for those diseases.
Oncology Nursing Society (ONS)—An organization of registered nurses and other healthcare providers dedicated to excellence in patient care, education, research, and administration in oncology nursing.
Partnership for Prescription Assistance (PPA)—Provides financial assistance to patients without prescription drug coverage.
Patient Access Network (PAN) Foundation—Provides co-pay assistance to underinsured patients.
Patient Advocate Foundation (PAF)—Case managers liaise with insurers, employers, and creditors on behalf of patients with chronic or life-threatening illnesses.
Patient Services Incorporated (PSI)—Helps chronically-ill patients who have insurance pay for their uncovered costs.

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Note: GlaxoSmithKline cannot take responsibility for information found on third-party Web sites outside its control. Please understand that the content of these third-party Web sites is subject to change without notice to GlaxoSmithKline. We therefore cannot be responsible for, and accept no liability for, any information or opinion contained in any third-party Web site.

Photos are for illustrative purposes only.
The CARES by GSK logo is a trademark of GlaxoSmithKline.

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