Posted by AndrewB on October 19, 2000, at 15:01:42
In reply to Cheapest source Wellbutrin SR /meds?, posted by DianeD on October 19, 2000, at 11:53:07
Diane,
This may be relevant to you:
Glaxo Wellcome Inc.
Program Name
Glaxo Wellcome Patient Assistance Program
Eligibility
The program offers assistance to financially disadvantaged, U.S. citizen patients who are uninsured, who
are in the process of applying or waiting approval for other sources of funding, or who are unable to
afford the cost of prescription medicine. Information on status of eligibility for insurance coverage,
including Medicaid) is required. Program does not look at patient assets but does look at medical spend
down.Program Benefits/Limits
Initial program enrollment provides for up to 90 consecutive days of medication, in increments of up to
30 days each. Continued assistance for additional 90-day enrollments is available in some cases. The
patient is asked to pay a nominal co-payment to the pharmacy each time the prescription is filled.Dosage limitations are not published, but based on individual patient need. If prescription exceeds the
limit, physician will receive via fax a Letter of Quantity Justification which is to be signed and faxed back
before dosage is authorized.The Patient Assistance Program staff is also available to work with patient advocates to find other
sources of drug assistance to help them obtain their medications. This program is called Reimbursement
Case Management.Application Process
With patient consent, physician or other patient advocate requests an enrollment packet which he/she
will receive within 10 days. Enrollment packet includes five application forms. (Patient advocate can be
doctor, pharmacist, nurse, social worker, billing department representative or similar health care
provider.) The patient advocate works with the patient to fill out the program application form and
then contacts Glaxo Wellcome by telephone to establish initial patient eligibility. The patient
advocate provides the patient with the prescription benefit card from the application form which the
patient can take immediately to a pharmacist for an initial 30-day supply of the medication. The
completed application forms are forwarded to the Patient Assistance Program within 30 days to
establish eligibility for up to 90 days of prescription benefits. Advocate can call in any dosage changes
at any time.Required financial information includes household monthly income from all sources (salary, social
security, public assistance, etc.) and household non-reimbursable expenses. No income cap is available.
No documentation of income required for initial enrollment. It is necessary for the physician to sign off
on the application, which includes financial information. No proof of residency required.Renewal
At the end of each 30-day period during the first 90 days of enrollment, patient advocate must contact
the Patient Assistance Program and provide updated patient information for continuation of benefits.
Patients who qualify will be authorized medication in 30-day increments through the 90th day of
enrollment. To continue assistance, the patient will need to provide additional documentation (income
verification documentation such as pay stubs, SS letter and pending insurance information.). Patients
who qualify for continued assistance beyond 90 days will be authorized medication in 90-day increments.
No new enrollment form required. At each 90 day anniversary a letter will be sent to the advocate for
verification of income to be returned to activate renewal. No limit to number of renewals.Requests and Information
Glaxo Wellcome Patient Assistance Program
P.O. Box 52185
Phoenix, AZ 85072-9711
(800) 722-9294
poster:AndrewB
thread:46761
URL: http://www.dr-bob.org/babble/20001012/msgs/46776.html