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Getting Started When Medicine is Needed Right Away
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Complete, print and sign the application.
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Gather income documentation.
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Ask someone involved in the delivery of your healthcare services to be your advocate.
To enroll
- Review the completed application and documents with your advocate.
- Have your advocate call 1-866-PATIENT (1-866-728-4368) to enroll you in Bridges to Access.
- During the enrollment phone call, your advocate will be told whether or not
you qualify for the program.
To Receive Medicine
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Use the voucher from the bottom of the application at any
retail pharmacy to receive your medicine that same day.
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Bring your prescription, the voucher, and a $10 co-pay to your local pharmacy.
You will get up to a 60-day supply of your GlaxoSmithKline medicine.
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Mail the application, income documents
and a prescription for your GlaxoSmithKline medicine to Bridges to Access.
Bridges to Access will process your application and if eligible your medicine
will automatically be sent to the address provided on the application.
To Order Refills
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Have the prescription number ready and order refills here
or call 1-866-PATIENT (1-866-728-4368). Be sure to order your refills 3 weeks before you run out of medicine.
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Refills are sent at no cost for up to 12 months after your enrollment in Bridges to Access.
To Re-Apply
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You will need to re-apply to Bridges to Access every 12 months to continue receiving
assistance for your GlaxoSmithKline medicine(s).
Bridges to Access will mail a re-enrollment application when it is time to re-apply.
You can re-enroll on your own by mailing in the completed form or you can ask someone
involved in your healthcare to help you complete the form and mail it in.
If you are still eligible for continued assistance through Bridges to Access, your first refill will
automatically be sent to the address provided on the application.
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