GSK (Bridges to Access) Patient Assistance Program

Requirements for uninsured applicants

• Applicants must be at or below 250% federal poverty level to qualify.
  • View federal poverty guidelines.
• This company does not require income documentation from the applicant in order to apply, the program will perform a soft credit inquiry to verify income
• There is a link for an online refill portal for you to use to refill medications once you are enrolled in the program
  • https://www.walgreens.com/pharmacy/thirdpartyrefill/third_party_refill_pres_info.jsp?key=bridges
• A registered advocate at your physician’s office needs to fill of the advocate section of the application
  • Your physician’s office is required to send in a hard copy with the application for the medication to be filled
• Medications are be shipped directly to the applicants home 3 months at a time
• Applications are good for 1 year from the date approved by the program

Requirement for Medicare Part D applicants

• Medicare Part D enrollees are required to have spent $600 out of pocket on medications year to date before they are able to apply
  • You must send in a print out from you pharmacy to verify you have spent this amount on medications along with you application.
• Applications for Medicare Part D enrollees are valid until December 31st of the current enrollment year