Together with GSK Oncology Commercial Co-pay Assistance Program: Zejula

Funded

About

The Together with GSK Oncology Commercial Co-pay Assistance Program: Zejula provides significant financial assistance for patients who are prescribed Zejula. The program ensures eligible commercially insured patients can benefit from reduced treatment costs, potentially paying as little as $0 per treatment up to a maximum benefit cap of $26,000 per year. This program is designed to alleviate the financial burden for Zejula recipients, making it an invaluable resource for those who qualify.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$26000 annual maximum benefit

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Eligible commercially insured patients may pay as little as $0 per treatment

•Maximum benefit of $26,000 for 12 months

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

•HCP and patient should complete enrollment form (https://www.togetherwithgskoncology.com/content/dam/cfpharma/togetherwithgskoncology/master/pdf/zejulaenrollmentformpatientreimbursementsupportprogram.pdf) and fax

•to 18006459043

•Patient may enroll online, or HCP may enroll patient online

•Call 8444475662, MondayFriday 8 AM to 8 PM ET, for more information

Enrollment Forms

Enrollment Form