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GlaxoSmithKline Bridges to Access

Summary:

GlaxoSmithKline was founded in 2000 through the merger of GlaxoWellcome and SmithKiline Beecham. GlaxoWellcome was formed in 1995 through the merger of Burroughs Wellcome (founded in London in 1880) and Glaxo Laboratories (founded in Bunnythorpe, New Zealand in the 1930s). Smithkiline Beecham was founded through the merger of Beecham (founded in England by Thomas Beecham in 1843) and SmithKline Beckman (founded in Philadelphia by John K. Smith in 1830). Considering the exuberant amount of companies that merged to create GlaxoSmithKline and all of the acquisitions along the way, it's no wonder that they are considered to be the second largest pharmaceutical company in the world, with Pfizer as the first. GlaxoSmithKline focuses on the research and development of prescription products in the fields of anti-infectives, central nervous system, respiratory, gastro-intestinal/metabolic, oncology, and vaccines.

Eligibility:

GlaxoSmithKline Bridges to Access, a patient assistance program provided by GlaxoSmithKline, offers the medications listed to the right for the cost of a $10 co-pay for up to 1 year to those who are eligible for the program. Eligibility is based off of the following requirements:

- You must be a citizen of the United States or its Territories.

- You must not be covered by any private, public, or Medicare Part D prescription coverage programs.

- The patient must have an advocate handle this process on their behalf.

- Your income must be less than or equal to 250% of the Federal Poverty Guideline for the size of your household (see chart below).

Those eligible for Medicare Part D but not enrolled and are not eligible for the low income subsidy may still be eligible.

The patient is sent a voucher for the medication.

SOURCE: 2008 Poverty Chart
Family Size 100% 133% 150% 200% 250% 300%
1 $10,400 $13,832 $15,600 $20,800 $26,000 $31,200
2 $14,000 $18,620 $21,000 $28,000 $35,000 $42,000
3 $17,600 $23,408 $26,400 $35,200 $44,000 $52,800
4 $21,200 $28,196 $31,800 $42,400 $53,000 $63,600
5 $24,800 $32,984 $37,200 $49,600 $62,000 $74,400
6 $28,400 $37,772 $42,600 $56,800 $71,000 $85,200
7 $32,000 $42,560 $48,000 $64,000 $80,000 $96,000
8 $35,600 $47,348 $53,400 $71,200 $89,000 $106,800
For each additional family member $3,600 $4,788 $5,400 $7,200 $9,000 $10,800

What’s Next?

Fill out the program enrollment form located to your right. If you don’t see an enrollment form available please call GlaxoSmithKline program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.

Other Tips

  • If you have any questions please call the GlaxoSmithKline program directly
  • Fill out as much of the information on the enrollment form as possible. The more information you have pre-filled the easier the progrm is to enroll in
  • Write down the refill dates for your program and set a reminder here on PatientAssistance.com so that you don’t run out of medication.
  • Do not write messy on your forms as this will delay any response
  • Call and write thank you notes to GlaxoSmithKline program. Without their help millions of people will be without medication.




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    List of Medications:
    Advair Diskus Inhalation Powder 100/50, 250/50, 500/50 (fluticasone/salmeterol), Advair HFA (fluticasone/salmeterol), Albenza Tablets 200mg (albendazole), Altabax Ointment 1% (retapamulin Topical), Amerge Tablets 1mg, 2.5mg (naratriptan), Amoxil Capsules 500mg (amoxicillin), Amoxil Oral Solution 250mg/5ml, 400mg/5ml (amoxicillin), Amoxil Powder For Oral Suspension 50mg/ml, 125mg/5ml, 250mg/5ml (amoxicillin), Amoxil Tablets 400mg, 500mg, 875mg (amoxicillin), Amoxil Tablets-Chewable 200mg, 250mg (amoxicillin), Arixtra Injection 5mg, 7.5mg, 10mg (fondaparinux), Augmentin (amoxicillin/clavulanate), Augmentin (amoxicillin/clavulanate), Augmentin (amoxicillin/clavulanate), Augmentin Oral Solution (amoxicillin/clavulanate), Augmentin Powder For Oral Suspension 125mg/5ml, 200mg/5ml, 250mg/5ml, 400mg/5ml (amoxicillin/clavulanate), Augmentin Tablets 250mg, 500mg (amoxicillin/clavulanate), Augmentin Tablets-Chewable 125mg, 250mg, 400mg (amoxicillin/clavulanate), Augmentin ES Tablets 600mg (amoxicillin/clavulanate), Augmentin ES-600 Powder For Oral Suspension 600mg/5ml (amoxicillin/clavulanate), Augmentin XR Tablets (amoxicillin/clavulanate), Avandamet Tablets 2mg/500mg, 4mg/500mg, 2mg/1000mg, 4mg/1000mg (metaformin/rosiglitazone), Avandaryl Tablets 4mg/1mg, 4mg/2mg, 4mg/4mg (rosiglitazon/glimepiride), Avandia Tablets 2mg, 4mg, 8mg (rosiglitazone), Avodart Soft Gelatin Tablets 0.5mg (dutasteride), Axid Capsules 150mg, 300mg (nizatidine), Bactroban Cream (mupirocin Topical), Bactroban Nasal Ointment (mupirocin Topical), Bactroban Ointment (mupirocin Topical), Beconase AQ Nasal Spray 0.042% (beclomethasone Nasal), Ceftin Oral Suspension 125mg/5ml, 250mg/5ml (cefuroxime Axetil), Ceftin Tablets 125mg, 250mg, 300mg, 500mg, 600mg (cefuroxime Axetil), Combivir Tablets 60mg (lamivudine/zidovudine), Coreg Tablets 3.125mg, 6.25mg, 12.5mg, 25mg (carvedilol), Coreg CR Tablets 10mg, 20mg, 40mg, 80mg (carvedilol), Daraprim Tablets 25mg (pyrimethamine), Dexedrine Spansule Capsules 5mg, 10mg, 15mg (dextroamphetamine), Dyazide Capsules 37.5mg/25mg (hydrochlorothiazide/triamterene), Dynacirc CR Tablets 5mg, 10mg (isradipine), Epivir Oral Solution (lamivudine), Epivir Tablets 150mg, 300mg (lamivudine), Epivir-HBV Oral Solution (lamivudine), Epivir-HBV Tablets (lamivudine), Epzicom Tablets (abacavir/lamivudine), Flonase Nasal Spray 50mcg (fluticasone Nasal Spray), Flovent Aerosol Spray 220mcg (fluticasone), Flovent Inhaler 44mcg, 110mcg (fluticasone), Flovent Rotadisk 50mcg, 100mcg, 250mcg (fluticasone Inhalation Powder), Fortaz Injection 1gm/vial, 2gm/vial, 6gm/vial, 500mg/vial (ceftazidime), Imitrex Injection (sumatriptan), Imitrex Nasal Spray 5mg/unit, 20mg/unit (sumatriptan Nasal), Imitrex Tablets 25mg, 50mg, 100mg (sumatriptan), InnoPran XL Capsules 80mg, 120mg (propranolol), Lamictal Tablets 25mg, 100mg, 200mg (lamotrigine), Lamictal Tablets-Chewable 2mg, 5mg, 25mg, 150mg (lamotrigine), Lanoxicaps Capsules 50mcg, 100mcg, 200mcg (digoxin), Lanoxin Tablets 0.125mg, 0.25mg (digoxin), Lanoxin Pediatic Elixer 50mcg/50ml (digoxin), Lexiva Oral Suspension (fosamprenavir), Lexiva Tablets 700mg (fosamprenavir), Lovaza Capsules (omega-3-acid Ethyl Esters), Malarone Tablets 62.5mg/25mg, 250mg/100mg (atovaquone And Proguanil Hydrochloride), Malarone Pediatric Tablets (atovaquone And Proguanil Hydrochloride), Mepron Suspension (atovaquone), Parnate Tablets 10mg (tranylcypromine), Paxil Oral Suspension (paroxetine), Paxil Tablets 10mg, 20mg, 30mg, 40mg (paroxetine), Paxil CR Tablets 12.5mg, 25mg, 37.5mg (paroxetine), Relenza Powder For Inhalation (zanamivir), Requip Tablets 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg, 5mg (ropinirole), Retrovir Capsules 100mg (zidovudine), Retrovir Syrup (zidovudine), Retrovir Tablets 300mg (zidovudine), Rythmol Tablets 150mg, 225mg, 300mg (propafenone), Rythmol SR Capsules 225mg, 325mg, 425mg (propafenone), Serevent Diskus Powder For Inhalation 50mcg (salmeterol Inhaled), Timentin Injection (ticarcillin/clavulanate), Timentin IV (ticarcillin/clavulanate), Treximet Tablets (sumatriptan/naproxen Sodium), Trizivir Tablets 300mg/150mg/300mg (abacavir/lamivudine/zidovudine), Valtrex Caplets (valacyclovir), Ventolin HFA Inhaler (albuterol Inhalers), Veramyst Nasal Spray (fluticasone Nasal Spray), VESIcare Tablets 5mg, 10mg (solifenacin), Wellbutrin Tablets 75mg, 100mg (bupropion), Wellbutrin SR Tablets 100mg, 150mg, 200mg (bupropion), Wellbutrin XL Tablets 300mg (bupropion), Zantac Injection (ranitidine), Zantac Injection Premixed (ranitidine), Zantac Syrup (ranitidine), Zantac Tablets 150mg, 300mg (ranitidine), Zantac EFFERdose Tablets 150mg (ranitidine), Ziagen Oral Solution (avacavir Sulfate), Ziagen Tablets (abacavir), Zinacef Injection (cefuroxime For Injection), Zofran Tablets 4mg (ondansetron), Zofran Tablets-Orally Disintergrating 4mg, 8mg (ondansetron), Zovirax Capsules (acyclovir), Zovirax Suspension (acyclovir), Zovirax Tablets 200mg (acyclovir), Zyban Tablets (bupropion)

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