How to Enroll in GSK Access

Follow these three easy steps when applying to GSK Access. Detailed instructions can be found on the application.

1. Complete and Sign the Application

  • Complete all required sections of the GSK Access enrollment application.
    • To view the enrollment application, you will need Adobe® Acrobat® Reader. If you do not have it, click here to download a copy.
  • Be sure to sign and date the "Patient Authorization to Release and Disclose Medical Information" section on Page 4 of the application.

Complete Your Application Now by filling it out online and then printing.

2. Include the following documents

A copy of your Medicare Part D Prescription Plan ID Card - DO NOT SEND the original card.

Proof of Prescription Expenses and Income

  • Proof that you have spent $600 out-of-pocket on prescription medications. Documentation includes all pages of your most recent Medicare Part D prescription drug plan statement (Explanation of Benefits – EOB) indicating you have paid a total of $600 for prescriptions in the current calendar year. If your statement is not available, please call GSK Access for help to identify other sources of proof at 1-866-518-4357.

    NOTE: The $600 expenditure can be co-pays, deductibles and direct costs for any prescription medication. The prescription expenses must not include monthly premiums or expenses of family members.

An original signed prescription for your GSK medicine.

  • Faxed prescriptions are only valid if they are faxed directly from a physician’s office. Faxed prescriptions received from any other location will not be accepted and will delay medication shipment to the patient.

(Note: Be sure to print the applicant's name and date of birth on each page of documentation submitted.)

3. Submit Your Application and Documentation

  • Mail or fax your completed application along with all required documentation to:
    GSK Access
    PO Box 52046
    Phoenix, AZ 85072-2046
    Fax Number: 1-866-518-3994

    If enrollment documents are submitted by mail, submit copies of Proof of Household Income documents and of your Medicare Part D Prescription Plan ID Card. Do not mail original income or tax documents, or your original Medicare Part D card. Documents submitted cannot be returned.

  • Once the completed application is received, it is typically processed within two business days. Notification of acceptance or denial will be sent by mail. If approved, and we have received a valid prescription for you, your first fill of GSK medicine will be shipped to you.
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