ZEJULA (niraparib)

Together with GSK Oncology is here to help.

For healthcare professionals—and their patients—Together with GSK Oncology offers:

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 1-800-645-9043

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.

DOWNLOAD FORM

Co-pay Assistance

Eligible commercially insured patients could pay as little as $0 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 GSK’s Patient Assistance Program (PAP). Medicare patients who meet program requirements may also be eligible for GSK’s 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) has residential, insurance, and income eligibility requirements. This calculator can help determine whether the patient might be eligible.

CHECK ELIGIBILITY

Sample Payer Letters

Together with GSK Oncology cannot submit letters on behalf of physicians or patients, however we have included sample letters that you can customize based on the patient’s condition and the requirements of the plan.

MEDICAL NECESSITY APPEAL

Co-pay Assistance Eligibility Check

To enroll your patients in the co-pay assistance program, you or the specialty pharmacy should complete the information through the link below. Please note that patient signature is required.

PROCESS ELIGIBILITY

Quick Start and Bridge Program

For patients experiencing delay in coverage at first dispense (Quick Start), or coverage interruptions while already on treatment (Bridge), download and fill out the enrollment form then fax to Together with GSK Oncology at 1-800-645-9043 to check for eligibility.

START ENROLLING

Savings & Support

Explore the dedicated support your patients will receive throughout their treatment journey with ZEJULA.

GET STARTED