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GlaxoSmithKline Bridges to Access Program
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PO Box 29038,Phoenix, AZ 85038-9038
Phoenix, AZ 85038-9038
Phone
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866-728-4368
Fax:
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Eligibility
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The patient must have no prescription coverage for the requested medication and have an income at or below 250% of the Federal Poverty Level. The patient must also be a US resident. |
Who Can Apply
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The patient advocate can call for an application or start the application process on line. |
Required
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The doctor must fill out a section, sign the application and attach a prescription.The patient must fill out a section, sign the application, and attach proof of income and any denial letters from insurance companies. |
Supply
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Ship To
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Patient's home advocate |
Note
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The patient advocate can call for an application or start the application process on line. |
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Includes Support for This Drug NOTE: Linked drugs are available for Prescribers to Apply Online now. Click drug logo or drug name to start online application. |
Agenerase Oral Solution |
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