JEMPERLI (dostarlimab-gxly)
Together with GSK Oncology is here to help.
Sign up for Together with GSK Oncology today. Our access and reimbursement services can help you get started on your treatment journey with JEMPERLI.
Together with GSK Oncology Enrollment Form
Download and print this form to bring to your next doctor’s appointment. Your provider will need to complete the “Prescriber Information” section, and you will both need to sign the form. Then, your provider will submit it (plus copies of your medical and pharmacy insurance cards) for approval.
You should receive a call from Together with GSK Oncology within 2 business days.
Co-pay Assistance
You may be eligible for the Together with GSK Oncology Co-pay Program for commercially insured patients. To apply, download the enrollment form today to complete at your next doctor's office visit. If approved, you could pay as little as $0 up to a total of $26,000 for up to 12 months for your medicine, subject to the program maximum. Terms and Conditions apply.
Patient Assistance Program (PAP)
Eligible uninsured patients may access medication free of charge through the GSK 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.
Prior Authorization and Appeals Support*
- Research plan requirements
- Outline the steps in the prior authorization process
Sign up for Co-pay Text Messages
Certain Co-pay Program updates are available by text message. If you would like to receive messages via text, opt-in on the enrollment form. (Msg & Data Rates May Apply).
Benefits Investigation*
- Contact insurance companies to obtain specific coverage information
- Check payer’s prior authorization requirements
- Determine your estimated out-of-pocket cost
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)
*The ultimate coverage or reimbursement determination is up to the payer. Together with GSK Oncology does not guarantee coverage or payer reimbursement for product treatment or administration.
