Eligibility Questions

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Please answer the questions below to see if your patient may qualify for the Together with GSK Oncology Copay Program for OJJAARA.

My patient is 18 years of age or older.

Yes

Is your patient enrolled in any of the following: Medicare, Medicaid, VA, DOD, or TRICARE?

Yes

Patients are not eligible for this program if they are covered by any federal or state prescription insurance program. This includes patients enrolled in Medicare Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD) programs or TriCare. This may also include state pharmaceutical assistance programs and other federal or state plans not listed. Patients are also ineligible for this program if they are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. Patients enrolled in a state or federally funded prescription insurance program may not use this program even if they elect to be processed as an uninsured (cash paying) patient. Those on Medicare Part D, even if in the coverage gap, are not eligible. Patients enrolled in private indemnity of HMO insurance plans that reimburse them for the entire cost of their prescription drugs are also not eligible.

Is your patient a resident of the US (including the District of Columbia, Puerto Rico, and the US Virgin Islands)?

Yes

Does the Patient have commercial insurance?

Yes

By checking this box, I agree that I read, understand and accept the Terms & Conditions of the Together with GSK Oncology Copay Program for OJJAARA.

Health insurance you or a family member purchased and/or receive through an employer, healthcare exchange, or a commercial plan through the Federal Employee Health Benefits (FEHB) program.

Includes Medicare Part D, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs.

Enrollment Process 1 2 3 4 5

Eligibility Questions

Enrollment
Process

1 2 3 4 5