If You Have Medicare Part D

This section provides information about the GSK Patient Assistance Program for patients who have Medicare Part D.

Eligibility

To qualify for the GSK Patient Assistance Program, you must:

Live in the United States or Puerto Rico
Have a Medicare prescription drug plan and meet other program requirements
Not be eligible for Puerto Rico's Government Health Plan Mi Salud, or have applied and been denied
Have paid a total of $600 for prescriptions in the current calendar year

48 States and DC
Household Size	Maximum Annual Gross Income
1	$46,950
2	$63,450
3	$79,950
4	$96,450
For each additional person, add	$16,500

Calculate your annual income limit if you have more than 4 people living in your household, including yourself.

Alaska
Household Size	Maximum Annual Gross Income
1	$58,650
2	$79,290
3	$99,930
4	$120,570
For each additional person, add	$20,640

Calculate your annual income limit if you have more than 4 people living in your household, including yourself.

Hawaii
Household Size	Maximum Annual Gross Income
1	$53,970
2	$72,960
3	$91,950
4	$110,940
For each additional person, add	$18,990

Calculate your annual income limit if you have more than 4 people living in your household, including yourself.

Puerto Rico
Household Size	Maximum Annual Gross Income
1	$28,800
2	$36,000
3	$43,200
4	$50,400
For each additional person, add	$7,200

Calculate your annual income limit if you have more than 4 people living in your household, including yourself.

*
Subject to eligibility, program terms, and conditions, which are subject to change. Programs do not constitute health insurance.

See access and copay assistance programs for certain products.

Learn about the GSK Patient Assistance Program for Vaccines.

Please take a look at our FAQs.