GSK Patient Assistance Program provides certain GlaxoSmithKline prescription medicines—at no cost—to qualified patients. This program does not constitute health insurance.

How to Apply

Please either download the application below (if available) or go to the program website for more information on how to apply. Once you fill out your application, send it to the address on the application. Remember not to send program applications to PPA.

Product(s) Covered by Program

  • A

    • Advair® Diskus
    • Advair® HFA
    • Advair® HFA 115/21
    • Advair® HFA 230/21
    • Advair® HFA 45/21
    • ANORO ELLIPTA
    • ARNUITY™ ELLIPTA®
    • Avandia® 2mg
    • Avandia® 4mg
  • B

    • Beconase AQ®
    • Boostrix®
    • Breo Ellipta
  • C

    • Coreg CR®
  • E

    • Engerix-B
    • Epivir®
  • F

    • Flovent® HFA w/dosage counter
  • H

    • Havrix
  • I

    • Imitrex® Nasal Spray
    • INCRUSE® ELLIPTA®
  • J

    • Jalyn™
  • L

    • Lamictal®
  • M

    • Malarone Tablets
    • Malarone®
    • Mepron®
  • R

    • Rabavert
    • Relenza®
    • Requip XL®
  • S

    • Serevent Diskus®
    • Soriatane®
  • T

    • TANZEUM™
  • V

    • Ventolin® HFA