Programas de asistencia al paciente para Boostrix

Solicite apoyo para su receta con Boostrix

Si califica, los programas a continuación le pueden ser útiles para conseguir Boostrix. Revise la información para saber si califica. Las solicitudes están disponibles en formato PDF y deben enviarse directamente a quien proporciona el programa de asistencia al paciente.

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GSK Patient Assistance Program

(Programa 1 de 1 — Para visualizar todos, deberá desplazarse hacia abajo )

Provienen de: GlaxoSmithKline
PO Box 220590 Charlotte, NC 28222-0590
TEL: 866-728-4368
FAX: 855-474-3063
Idiomas hablados:
English, Others By Translation Service
La Página del Programa
Medicamentos
  • Boostrix (tetanus toxoid reduced diphtheria toxoid-acellular pertussus vaccine absorbed)
Requisitos de Elegibilidad
  • Insurance Status Must be uninsured
  • Those with Part D Elibible? Yes, but contact program for details
  • Income At or below 250% of FPL
  • Diagnosis/Medical Criteria Not required
  • U.S. Residency Required? The patient must live in one of the 50 states, the District of Columbia, or Puerto Rico* and utilize the US healthcare system
Solicitud
  • Obtaining Call or download from Programs website
  • Receiving Faxed, mailed or downloaded from Programs website
  • Returning Fax or mail (Note: faxed prescriptions are only valid if faxed directly from a prescriber's office)
  • Doctor's Action Fax in prescription
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified in writing
  • Decision Timeframe Within 2-3 days
Medicamento
  • Amount/Supply Up to 90 day supply
  • Sent To Patient's home, doctor's office, or the advocate's facility
  • Delivery Time Not specified
  • Refill Proces Good for 12 months
  • Limit Not specified
  • Re-application New application yearly
Información Adicional
Patients may apply on their own or with the help of an advocate. Fax or mail enrollment documents to the program with patient name and date of birth on each page (faxed prescriptions are only valid if faxed directly from a prescriber's office). Eligible patients may receive 90 day supply of medicine to their home within 7 days of faxed enrollment (mailed enrollments may take longer to receive medicine). If enrollment documents are submitted by mail, submit ONLY COPIES of Proof of Household Income documents. Do not mail original income or tax documents. Documents submitted cannot be returned. Prescriber must register for the Vaccines patient assistance program only. Enroll online at GSKPatientAssistanceProgramPortal.com. *Puerto Rico Residents do not qualify for vaccine products.
Actualizado June 28, 2019

Si usted, su paciente o un ser querido no es elegible para este programa o otros, se pueden encontrar precios de aquí.

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