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Eligibility Criteria |
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Patients must meet all of the following guidelines to qualify for Commitment to Access:
- Financial Requirements
- Insurance Requirements
- Residency Requirements
Please see details below.
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Financial Requirements |
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For GlaxoSmithKline oncology and specialty pharmacy products:
- Have gross monthly household income at or
below the following amounts:
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48 Contiguous States and District of
Columbia
Size of Family Unit |
Monthly Gross Income |
1 |
$4,512.50 |
2 |
$6,070.83 |
3 |
$7,629.17 |
4 |
$9,187.50 |
For each additional
person, add |
$1,558.33 |
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Alaska
Size of Family Unit |
Monthly Gross Income |
1 |
$5,637.50 |
2 |
$7,587.50 |
3 |
$9,537.50 |
4 |
$11,487.50 |
For each additional
person, add |
$1,950.00 |
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Hawaii
Size of Family Unit |
Monthly Gross Income |
1 |
$5,191.67 |
2 |
$6,983.33 |
3 |
$8,775.00 |
4 |
$10,566.67 |
For each additional
person, add |
$1,791.67 |
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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. |
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Insurance Requirements
Patients who are not enrolled in Medicare Part D can not have third party prescription drug coverage except generic-only 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.
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.
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