How does the Benlysta copay program work?

With a Benlysta copay program or copay card, you may pay as little as $0 for out-of-pocket costs, if you have commercial insurance.

How do I qualify for a Benlysta Copay Program?

You are eligible for the Benlysta copay card if you have a commercial or prescription insurance plan, have a valid prescription for Benlysta, and your medicine must be dispensed at participating eligible pharmacies in the United States (including the District of Columbia, Puerto Rico, and the US Virgin Islands). The Benlysta Gateway enrollment form is available online. Check the Benlysta Copay Card Terms & Conditions for more details.

Residents of Massachusetts, Minnesota, and Rhode Island are not eligible for reimbursement of administrative fees.

You are not eligible for the Benlysta copay card if you are covered by any federal or state prescription insurance program. This also includes if you are 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 the Benlysta copay 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. Patients enrolled in private indemnity of HMO insurance plans that reimburse them for the entire cost of their prescription drugs are also not eligible

How much will I save with a Benlysta Copay Card?

With the Benlysta copay card you could pay a little as $0 for Benlysta, but prices vary depending on your insurance provider and other factors. There are Copay Program Maximum for patients for different insurance types.

For patients who are enrolled in an insurance plan that credits the amount of the GSK Copay Program toward their plan out-of-pocket responsibilities for Benlysta (e.g., copayments, coinsurance, annual deductibles, and annual out-of-pocket maximums), the Benlysta Copay Program Maximum is $9,450 annually. The Copay Program Maximum for patients determined to be enrolled in high deductible health plans is up to $15,000 annually.

For patients who are enrolled in maximizer plans the Copay Program Maximum is $5,000 annually. A maximizer plan is an insurance plan that sets an individual’s cost-sharing amount at the maximum value of the manufacturer’s copay assistance. Maximizer plans do not credit the amount of the GSK Copay Program toward the patient’s deductible and annual out-of-pocket maximums.

For administration of the medicine, the Copay Program Maximum is $100 per administration and counts towards the annual copay program maximums as described above.

See the Benlysta Copay Terms & Conditions for details.

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How do I apply for the Benlysta Copay Card?

You can apply for the Benlysta Copay Card online using the link on the Benlysta Price Guide page. Answer the questions, fill out your details, and confirm the information. If you are entitled to a Benlysta copay card, you will be contacted.

You can also download and print the Benlysta Gateway enrollment form, answer the questions, fill out your details, sign, and then fax to 1-877-850-9901. If you are entitled to a Benlysta copay card, your benefits information will be sent to you by mail. You may receive a phone call from your specialty pharmacy or Gateway Representative. If you do not hear from your doctor’s office or specialty pharmacy within the next 2 weeks, you should contact your doctor’s office to check on the progress.

How do I contact Benlysta patient assistance program for support?

For any assistance for the Benlysta Copay program or Benlysta gateway enrollment form, please call 1-877-4-BENLYSTA (1-877-423-6597) M–F, 8 am–8 pm ET