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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
products, except Tykerb:
- 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 |
$3,033.33 |
2 |
$4,083.33 |
3 |
$5,133.33 |
4 |
$6,183.33 |
For each additional
person, add |
$1,050.00 |
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Alaska
Size of Family Unit |
Monthly Gross Income |
1 |
$3,791.67 |
2 |
$5,104.17 |
3 |
$6,416.67 |
4 |
$7,729.17 |
For each additional
person, add |
$1,312.50 |
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Hawaii
Size of Family Unit |
Monthly Gross Income |
1 |
$3,488.33 |
2 |
$4,695.83 |
3 |
$5,903.33 |
4 |
$7,110.83 |
For each additional
person, add |
$1,207.50 |
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Please call the GSK Response Center at 1-888-825-5249 for more
information.
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For Tykerb:
Have gross monthly household income at or
below the following amounts:
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48 Contiguous States and District of
Columbia - Tykerb
Size of Family Unit |
Monthly Gross Income |
1 |
$4,333.33 |
2 |
$5,833.33 |
3 |
$7,333.33 |
4 |
$8,833.33 |
For each additional
person, add |
$1,500.00 |
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Alaska - Tykerb
Size of Family Unit |
Monthly Gross Income |
1 |
$5,416.67 |
2 |
$7,291.67 |
3 |
$9,166.67 |
4 |
$11,041.67 |
For each additional
person, add |
$1,875.00 |
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Hawaii - Tykerb
Size of Family Unit |
Monthly Gross Income |
1 |
$4,983.33 |
2 |
$6,708.33 |
3 |
$8,433.33 |
4 |
$10,158.33 |
For each additional
person, add |
$1,725.00 |
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Please call the GSK
Response Center at 1-888-825-5249 for more information. |
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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.
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. Patient’s 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.
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