Program Contact Info / Application Submission
Program	GSK Access
Company	GlaxoSmithKline
Address	PO Box 52046 Phoenix, AZ 85072-2046
Phone	1-866-518-4357 (open M-F 8-8 EST)
Fax	1-866-518-3994
Website	www.gsk-access.com
Program Details
Details	If approved, the applicant will be mailed a pharmacy card. The card may be used at any retail pharmacy to pick up GlaxoSmithKline medicines at no cost.
Program Requirements
Information	Patient must fill out the entire application and attach a copy of his/her Medicare Part D Plan card. Must also attach the most recent explanation of benefits from the applicant�s Medicare Part D Prescription Drug Plan or a printout from the local pharmacy listing year-to-date prescription expenses. Prescription expenses must total $600 or more to be eligible. Do not include expenses from other family members. Monthly premiums or other medical expenses will not count toward the $600 total. If applicable, provide a copy of Low Income Subsidy Notice of Denial as well. Be sure to print the applicant�s name and date of birth on each page submitted.
Details	Insurance card NOT required Proof of Income NOT required Form 4506T (If taxes were not filed) NOT required as proof of income
Delivery of Medication
Delivery Options	Can NOT be delivered directly to the patient
Application Process
App Process	Send in a completed application along with income documentation and proof of prescription expenses. Applicants will be notified if they qualify for the program and, if approved, a pharmacy card will be mailed to the applicant. The card may be used at any retail pharmacy to pick up GlaxoSmithKline medicines at no cost. Drugs received from this program do not count toward True Out-of-Pocket Spending (TrOOP).
New Applications	New applications NOT accepted Patients can NOT apply directly to the program Can NOT apply for a new application via mail
Eligibility
Eligibility	Must be Medicare Part D enrolled with an income that is at or below 250% of the Federal Poverty Level. Must have already spent $600 on outpatient medicines in the current calendar year. Must be a US resident in one of the 50 states or District of Columbia. If the applicant�s income is below 135% of the Federal Poverty Level, the applicant will be required to apply for the Social Security Administration Low Income Subsidy prior to applying for GSK Access. Low Income Subsidy provides assistance that will pay for the costs of medicines through the Medicare Part D prescription drug plan. If the applicant has applied for Low Income Subsidy and was denied full assistance, a copy of the Notice of Denial letter from the Social Security Administration must be submitted to GSK Access.
Limitations	Patients are NOT eligible if LIS is denied Patients are NOT eligible if they are accepting Medicare part D