JEMPERLI (dostarlimab-gxly)
Together with GSK Oncology is here to help.
For healthcare professionals—and their patients—Together with GSK Oncology offers:
PROVIDER PORTAL LOG IN
Help Your Patients Enroll Today
Complete this form with your patient and return
- Select services requested from Together with GSK Oncology
- Complete all Patient and Prescriber Information
- Make sure both you and your patient sign the form
- Fax completed form, plus copies of patient’s medical and pharmacy insurance cards to 1-844-475-4662
Together with GSK Oncology will contact your office by the next business day—and will conduct a summary-of-benefits call with the patient within 2 business days.
Copay Assistance
Eligible commercially insured patients could pay as little as $0 up to a total of $26,000 for up to 12 months for their medicine. Download and complete the Together with GSK Oncology enrollment form with your patient to submit for approval. Terms and Conditions apply.
Patient Assistance Program (PAP)
Uninsured patients who meet eligibility requirements may access medication free of charge through the Together with GSK Oncology Patient Assistance Program (PAP) offered by the GSK PAP Foundation. Medicare patients who meet program requirements may also be eligible for the Patient Assistance Program. Check Eligibility.
Coverage Support*
- Patient-specific benefits investigation
- Prior authorization and appeals support
Claims Assistance*
Together with GSK Oncology can provide your practice with assistance for claims submissions; including providing examples of forms and sample letters, outlining payer-specific information.
Want more information?
We’re here to help.
Call us at 1-844-4GSK-ONC
(1-844-447-5662)
Monday-Friday (8 AM to 8 PM ET)
*Together with GSK Oncology provides informational resources for patients and healthcare professionals; specific eligibility requirements are determined by the payer; therefore, patients and healthcare professionals should confirm information directly with payers. Together with GSK Oncology does not guarantee coverage or payer reimbursement for product treatment or administration.
Patient Assistance Program Eligibility Calculator
The GSK Patient Assistance Program (PAP) offered by the GSK PAP Foundation has residential, insurance, and income eligibility requirements. This calculator can help determine whether your patient might be eligible.
About JEMPERLI
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