Benlysta Co-pay Assistance Program

Funded

About

The Benlysta Co-pay Assistance Program provides significant financial relief for patients prescribed Benlysta by offering a $0 copay, covering costs up to $15,000 annually for eligible patients. This program is designed to ensure that more patients can access the benefits of Benlysta without the burden of high out-of-pocket expenses. It supports patients with commercial insurance, excluding those enrolled in government-funded plans, across most of the United States, including the District of Columbia, Puerto Rico, and the US Virgin Islands.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•$0 copay for eligible patients, up to $15,000 for 12 months

•The Copay Program Maximum for patients who are enrolled in maximizer plans is $5,000 annually

•The Copay Program Maximum for patients who are enrolled in an insurance plan that credits the amount of the GSK Copay Program toward their plan outofpocket responsibilities for BENLYSTA (e.g., copayments, coinsurance, annual deductibles, and annual outofpocket maximums) is $9,450 annually

•Patients must submit an enrollment form or complete eligibility check online at https://www.benlystacopayprogram.com/ so that their eligibility can be determined

•Copay will now have a voucher and debit card combo for payment

•Patients must reenroll every 12 months (esign reenrollment is available); they will be sent a renewal letter one month before their enrollment expiration date

•Patients who receive BENLYSTA from a healthcare provider are covered up to $100 for each inoffice administration. Residents of Massachusetts, Minnesota, and Rhode Island are not eligible for reimbursement of administrative fees

•Doctor's office visits, labs, and other ancillary services are not included in the CoPay Program

•Contact the BENLYSTA Copay program at 8007410375, MondayFriday, 8 am8 pm Eastern Time

Enrollment Forms

Enrollment Form