What is Commitment to Access?

Commitment to Access is GlaxoSmithKline’s patient assistance program which provides assistance for its oncology medicines to eligible patients without drug coverage as well as eligible Medicare Part D enrollees who have spent at least $600 on out of pocket prescriptions this year.

What are the eligibility criteria to enroll?

To be eligible for Commitment to Access a patient must be a resident and meet certain financial and third party coverage requirements.

Financial Requirements
For GlaxoSmithKline oncology products, except Tykerb: Have gross monthly household income at or below the following amounts:
48 Contiguous States and District of Columbia Size of Family Unit Monthly Gross Income 1 $2,977.92 2 $3,992.92 3 $5,007.92 4 $6,022.92 For each additional person, add $1,015.00
Alaska Size of Family Unit Monthly Gross Income 1 $3,724.58 2 $4,993.33 3 $6,262.08 4 $7,530.83 For each additional person, add $1,268.75	Hawaii Size of Family Unit Monthly Gross Income 1 $3,427.08 2 $4,593.75 3 $5,760.42 4 $6,927.08 For each additional person, add $1,166.67
Please call the GSK Response Center at 1-888-825-5249 for more information.
For Tykerb: Have gross monthly household income at or below the following amounts:
48 Contiguous States and District of Columbia - Tykerb Size of Family Unit Monthly Gross Income 1 $4,254.17 2 $5,704.17 3 $7,154.17 4 $8,604.17 For each additional person, add $1,450.00
Alaska - Tykerb Size of Family Unit Monthly Gross Income 1 $5,320.83 2 $7,133.33 3 $8,945.83 4 $10,758.33 For each additional person, add $1,812.50	Hawaii - Tykerb Size of Family Unit Monthly Gross Income 1 $4,895.83 2 $6,562.50 3 $8,229.17 4 $9,895.83 For each additional person, add $1,666.67
Please call the GSK Response Center at 1-888-825-5249 for more information.
The definition of financial need is based on multiples of the federal poverty guidelines adjusted for household size. Patients with incomes above this amount may qualify through an adjustment to their income for certain medical expenses. Patients must provide documentation to verify their income, and in some cases may be required to submit insurance documentation.
Insurance Requirements Patients who are not enrolled in Medicare Part D can not have third party prescription drug coverage. Medicare Part D enrollees can enroll with proof that they have spent at least $600 on prescription medications through the Medicare Part D prescription Drug Plan in the current calendar year. Patients whose household income is less than 135% of the Federal Poverty Level, may qualify for full coverage of prescription drugs through LIS. A patient who qualifies for full LIS assistance, will need to use that benefit. Patients who are Medicare-eligible but not enrolled in a Medicare Part D Prescription Drug Plan must apply and be denied full Low Income Subsidy (LIS) assistance if their household income is less than 135% of the Federal Poverty Level. A patient who qualifies for LIS assistance, will need to use that benefit. Residency Requirements Commitment to Access residency includes anyone who lives in the United States (defined as one of the 50 states or the District of Columbia) and utilizes the United States healthcare system. A patient does not have to be a United States citizen to be eligible, however, someone who comes to the United States for the purpose of receiving healthcare services is not eligible. People who live outside the United States cannot participate in Commitment to Access regardless of citizenship status.

What is an Advocate?

Recognizing the important role that healthcare professionals play in the overall healthcare of patients, Commitment to Access uses “Advocates” to help patients enroll in our program. A patient must choose an Advocate to enroll in Commitment to Access. For the purpose of Commitment to Access, an Advocate is any non-family member who:

• has a relationship in the delivery of healthcare services to the patient and
• agrees to help the patient enroll and manage ongoing participation in Commitment to Access

Usually this is a physician, physician assistant, pharmacist, pharmacist technician, nurse, social worker or someone who works in the healthcare office or facility where the patient is being treated.

What are the roles and responsibilities of an Advocate?

An Advocate is responsible for the following:

• helping patients obtain, complete, and sign the one-page enrollment form;
• contacting Commitment to Access by phone to enroll patients;
• sending in documentation after telephone enrollment is complete;
• ordering most product refills for patients;
• helping patients re-enroll after a year, if needed;
• informing GSK of any prescription, address or income changes and
• helping patients with other Commitment to Access issues.

To become an Advocate, simply call 1-8-ONCOLOGY1 or click Register as An Advocate. Advocates will be issued a personal six-digit identification number for program use.

Advocates can view on-line information by visiting CommitmentToAccess.com for detailed program information, enrollment forms and password protected access to the advocate's on-line account. The on-line account provides the ability to search for patients and obtain their enrollment status, date of last refill, re-enrollment date and contact information.

How do patients enroll in Commitment to Access?

Patients must have an Advocate (see above). The patient, with the help of the Advocate, must complete and sign the one-page enrollment form. Once the enrollment form is completed and signed, the Advocate calls 1-8-ONCOLOGY1, M-F 8AM - 8PM ET, to enroll the patient by phone. Commitment to Access will make an immediate eligibility determination.

If the patient is eligible, the Advocate should fax a prescription for a 30-day supply of medicine (with up to 13 refills) to 1-800-853-7066. Upon receipt of the fax, the initial 30-day supply will be shipped to the prescriber or patient.

The Advocate sends the enrollment form with income and insurance documentation to: Commitment to Access, PO Box 29038, Phoenix, AZ 85038-9038. Do not mail the enrollment form, prescription or any other documentation until directed after the enrollment phone call.

See Enrollment Process/Timeline for more information.

How do Advocates and patients obtain or request enrollment forms?

Advocates: After signing onto this website. Advocates may:

• download a form on-demand or
• request forms be mailed.

• a single form by fax or
• a packet of ten forms by mail.

• downloading a single form or
• calling 1-8-ONCOLOGY1 to receive by fax or mail.

IMPORTANT: Each enrollment form has a unique nine-digit identification number that serves as the patient's Commitment to Access identification number for as long as the patient remains in the program. Each patient will need an original numbered enrollment form. Forms may not be photocopied.

How do eligible patients fill initial prescriptions and refills?

The advocate should fax a prescription for a 30-day supply of medicine (with up to 13 refills) to 800-853-7066 or 800-750-9832. After the receipt of the prescription and determination of the patient's eligibility, the initial 30-day supply will be shipped to the prescriber or patient. Refills: Advocates should call 1-8-ONCOLOGY1 approximately two weeks prior to the next scheduled treatment date to order refills.