ZEJULA Terms and Conditions
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Together with GSK Oncology Copay Program may help eligible commercially-insured patients* with their out-of pocket medication costs for Zejula
If approved, patients may pay as little as $0 for out-of-pocket costs for Zejula up to a maximum of $26,000.
Eligibility criteria
Patients may
be
eligible based on general eligibility criteria below:
*Eligibility restrictions and program maximums apply. Patients are not eligible for this program if they are
covered by any federal or state prescription insurance program. This includes patients enrolled in Medicare
Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD) programs or
TriCare. This may also include state pharmaceutical assistance programs and other federal or state plans not
listed. Patients are also ineligible for this program if they are Medicare eligible and enrolled in an
employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for
retirees. Patients enrolled in a state or federally funded prescription insurance program may not use this
program even if they seek to be processed as an uninsured (cash paying) patient.
Those on Medicare Part D,
even if in the coverage gap, are not eligible.
Additional program rules apply visit togetherwithgskoncology.com for complete Program Terms and Conditions.
For questions regarding the Together with GSK Oncology Copay Program for ZEJULA call
1-844-4GSK-ONC (1-844-447-5662)
(8am – 8pm EST, Monday–Friday)