Arnuity Ellipta

Indicated For

asthma

About This Medication

# GSK Patient Assistance Program Patient Guide: How to Get Arnuity Ellipta at Low or No Cost ## About This Program The **GSK Patient Assistance Program (PAP)** helps eligible patients obtain GSK medications, including Arnuity Ellipta (fluticasone furoate), at no cost. This program is managed by the GSK Patient Access Programs Foundation, an independent 501(c)(3) charitable foundation separate from GSK itself. The program does not constitute health insurance, and availability varies based on individual circumstances and product eligibility. ## What Is Arnuity Ellipta? Arnuity Ellipta is a prescription inhaled corticosteroid medication used to treat asthma. It helps reduce inflammation in the airways and prevent asthma symptoms. This medication requires a valid prescription from your healthcare provider and is only available through the patient assistance program if you meet specific eligibility criteria. ## Who Qualifies for This Program? You may be eligible for the GSK Patient Assistance Program if you meet the following requirements: - **Residency**: You live in the United States or Puerto Rico - **Insurance Status**: You are either uninsured or have Medicare prescription drug coverage and meet other program requirements - **Financial Need**: You meet the program's financial income eligibility criteria - **Puerto Rico Exception**: If you live in Puerto Rico, you are not eligible for Puerto Rico's Government Health Plan Mi Salud, or you have applied and been denied - **Valid Prescription**: You have a current prescription for Arnuity Ellipta from a licensed healthcare provider ## Income Eligibility The GSK Patient Assistance Program uses financial income thresholds to determine eligibility. While specific income limits vary based on household size and insurance status, the program generally serves patients with limited financial resources who struggle to afford their medications. **For Uninsured Patients**, income thresholds are based on household size: | Household Size | Maximum Annual Gross Income | |---|---| | 1 | $58,650 | | 2 | $79,290 | | 3 | $99,930 | | 4 | $120,570 | | Each additional person | Add $20,640 | **For Medicare Part D Patients**, different income limits apply. Contact the program directly at **(866) 728-4368** to confirm your specific eligibility threshold based on your household size and insurance type. ## Insurance Requirements The program serves two main groups: 1. **Uninsured Patients**: If you have no health insurance coverage, you may qualify if you meet the income thresholds listed above. 2. **Medicare Part D Patients**: If you have Medicare prescription drug coverage, you must also meet these additional requirements: - Have paid at least $600 out-of-pocket for prescriptions in the current calendar year - Meet other program-specific requirements - Provide your Medicare Beneficiary Identifier (MBI) and Part D ID card with your application **Note**: If you have private insurance, GSK also offers separate copay assistance programs that may help reduce your out-of-pocket costs. Contact the program to learn about these options. ## How to Apply: Step-by-Step ### Step 1: Gather Required Documents Before starting your application, collect the following: - **Completed Application Form**: Available from the GSK Patient Assistance Program - **Valid Prescription**: An original, signed prescription for Arnuity Ellipta written by your healthcare provider. Faxed prescriptions are accepted only if sent directly from your physician's office with a fax cover sheet. - **Proof of Income**: Documentation showing your household income (such as recent tax returns, pay stubs, or benefit statements) - **Proof of Residency**: A document confirming your U.S. or Puerto Rico address - **Medicare Information** (if applicable): Your Medicare Part D ID card and Medicare Beneficiary Identifier (MBI) **Important**: Do not send original documents—they will not be returned. Keep copies for your records. ### Step 2: Complete the Application - Fill out all required sections of the GSK Patient Assistance Program application form completely - Provide accurate personal information, including your name, date of birth, mailing address, and contact information - Sign and date the last page of the application with your original signature (stamped signatures are not accepted) - An incomplete application will delay processing ### Step 3: Submit Your Application You can submit your completed application by: - **Fax**: Send to the fax number provided on the application form - **Mail**: Send to the address listed on the application materials - **Phone**: Call **(866) 728-4368** for assistance with the application process **Program Hours**: Monday–Friday, 8 AM–8 PM ET The program staff can help you complete the application, answer questions about eligibility, and guide you through the submission process. ### Step 4: Authorization and Delivery Once your application is approved, GSK will ship your medication directly to you. The program will also contact your healthcare provider and pharmacist as needed to ensure proper administration and to verify that program guidelines are being met. ## Timeline and What to Expect While specific processing times are not detailed in program materials, you should expect: - **Application Review**: Your application will be reviewed for completeness and eligibility - **Verification**: The program may contact your healthcare provider, pharmacist, or insurance company to verify information - **Approval Notification**: You will be notified of your eligibility status - **Medication Delivery**: Once approved, your medication will be shipped to your address **Tip**: Keep copies of your application and all submitted documents for your records. Incomplete applications will result in processing delays, so ensure all sections are filled out before submitting. ## Reauthorization and Refills Your enrollment in the GSK Patient Assistance Program requires periodic reauthorization. This means you may need to: - Resubmit your application or updated information at specified intervals - Provide updated proof of income or insurance status - Confirm your continued eligibility with the program The program will notify you when reauthorization is needed. Stay in contact with the program to ensure uninterrupted access to your medication. ## What If Your Application Is Denied? If your application is denied, you have several options: 1. **Request Clarification**: Contact the program at **(866) 728-4368** to understand why you were not approved 2. **Explore Alternatives**: Ask about other GSK assistance programs, including copay assistance if you have private insurance 3. **Seek Additional Resources**: The program can help connect you with social workers, patient advocacy organizations, or other funding sources 4. **Reapply**: If your circumstances change (such as income reduction or insurance status), you may reapply ## Important Disclaimers - This program does not constitute health insurance - Program availability and eligibility requirements are subject to change - All information provided is based on current program guidelines; contact GSK directly for the most up-to-date details - This guide is for informational purposes and should not replace professional medical or financial advice - Consult with your healthcare provider about whether Arnuity Ellipta is appropriate for your medical condition ## Contact Information **GSK Patient Assistance Program** - **Phone**: (866) 728-4368 - **Hours**: Monday–Friday, 8 AM–8 PM ET - **Website**: Visit GSKForYou.com for more information and to find additional programs Program staff can answer questions about eligibility, help you complete your application, and provide support throughout the enrollment process.

Program information last verified: March 30, 2026