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People With Medicare

GSK Access

How does the program work?

This program helps people with limited incomes who are enrolled in a Medicare Part D plan. It helps them pay for medicines that GlaxoSmithKline makes.

You may be eligible for this program if you:

• Are enrolled in a Medicare Part D plan, AND
• Live in one of the 50 states or the District of Columbia, AND
• Meet income limits:
  • Are single and have an income of less than $26,351 per year. These income limits are higher if you live in Alaska or Hawaii.
  • Are married and have a joint income of less than $35,301 per year. These income limits are higher if you live in Alaska or Hawaii.
• Are taking a GlaxoSmithKline medicine that this program covers, AND
• Have spent at least $600 on prescription drugs this year.

If you qualify for this program, you can fill your prescriptions at your local pharmacy.

What medicines does it cover?

The program covers many different medicines that GlaxoSmithKline makes. For a list of medicines this program covers, visit the GSK program website.

How do I get in?

You must fill out and send in an application. With your application, you should send in:

• A copy of your Medicare Part D plan ID card;
• Proof of your income (such as a tax return or a Social Security statement);
• Proof that you have spent at least $600 on prescriptions this year, such as a statement from your Part D plan or from your pharmacy; AND

If I get in, what do I pay?

There is no enrollment fee. If you qualify for the program, your GlaxoSmithKline medicines will be free.

For more information

Visit the GSK program website, or call 1-866-518-HELP (4357).