ZEJULA (niraparib)

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 ZEJULA.

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.

DOWNLOAD FORM

Co-pay Assistance

You may be eligible for the GSK Co-pay Program for commercially insured patients. Download the enrollment form today to complete at your doctor’s office during your next visit. If approved, you could pay as little as $0 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 GSK’s Patient Assistance Program. Medicare patients who meet program requirements may also be eligible for GSK’s Patient Assistance Program. Check Eligibility

Benefits Investigation*

  • Contact insurance companies to obtain specific coverage information
  • Check payer’s prior authorization requirements
  • Determine your estimated out-of-pocket cost

Prior Authorization and Appeals Support*

  • Research plan requirements
  • Outline the steps in the prior authorization process

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.

Patient Assistance Program Eligibility Calculator

The GSK Patient Assistance Program (PAP) has residential, insurance, and income eligibility requirements. This calculator can help you determine whether you might be eligible.

CHECK ELIGIBILITY

Savings & Support

Explore the dedicated support you’ll get throughout your treatment journey with ZEJULA.

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