JEMPERLI

GSK Patient Assistance Program for JEMPERLI Patient Guide: How to Get JEMPERLI at Low or No Cost

About JEMPERLI (dostarlimab-gxly)

JEMPERLI is a prescription medicine used to treat adults with endometrial cancer (a type of uterine cancer).[3] It may be used alone or in combination with chemotherapy medicines (carboplatin and paclitaxel) depending on your specific condition.[3] JEMPERLI works by helping your immune system fight cancer cells.

Who Qualifies for This Program?

The GSK Patient Assistance Program for JEMPERLI is designed to help patients who cannot afford their medication.[2] You may qualify if you:

• Live in the United States, Puerto Rico, or US Virgin Islands[6]
• Have a valid prescription for JEMPERLI from your doctor
• Meet the income eligibility requirements for your household size and insurance status
• Are not enrolled in certain government-funded programs (though exceptions may apply)

Income Eligibility Requirements

Income limits vary based on your insurance status. The program serves uninsured patients, Medicare beneficiaries, and commercially insured patients.[2][6]

Uninsured Patients

Medicare Patients

Medicare beneficiaries have higher income thresholds. Contact the program at (844) 447-5662 for specific Medicare income limits, as they vary based on your prescription drug coverage status.[6]

Commercially Insured Patients

If you have commercial insurance, different income thresholds apply. Contact the program for details specific to your situation.[6]

Important Note About Medical Expenses

If your household income exceeds the program's maximum, you may still qualify by demonstrating that your eligible medical expenses bring you within the income eligibility criteria.[6] Contact the program to discuss your specific circumstances.

Insurance Requirements

You may qualify if you are:

• Uninsured (no health insurance coverage)[2]
• Medicare beneficiary with prescription drug coverage[6]
• Commercially insured but unable to afford your medication
• Functionally uninsured (contact the program for details on what this means)[2]

How to Apply: Step-by-Step

Step 1: Gather Required Documents

Before applying, collect the following:

• Proof of income (recent tax return, pay stubs, or other income documentation)
• Proof of residency (utility bill, lease agreement, or government-issued ID)
• Proof of insurance status (insurance card, denial letter, or documentation of being uninsured)
• Valid prescription for JEMPERLI from your doctor

Step 2: Complete Your Application

You have multiple enrollment options:

• Call the program at (844) 447-5662 to enroll over the phone
• Work with your healthcare provider to submit your application
• Enroll electronically through the program's online system

All new enrollment is now done electronically or by phone.[8]

Step 3: Submit Your Application

Provide all required documents along with your completed application. Your doctor may assist with this process.

Timeline and Medication Delivery

While specific processing times are not publicly listed, the program works to process applications promptly once all required documentation is received. Once approved, JEMPERLI will be shipped directly to you or your physician's office.[8]

If you experience a delay, temporary loss, or change in coverage, the program may provide a Bridge Program to help you continue treatment while your application is being processed.[8]

What If Your Application Is Denied?

If you are denied assistance, you have several options:

• Request reconsideration by contacting the program and providing additional information about your financial situation
• Explore independent foundations that may offer additional financial support for medications, coverage-related fees, or medical expenses[5]
• Ask your doctor about alternative treatment options or clinical trials
• Contact Together with JEMPERLI at the phone number above for guidance on next steps

Reauthorization and Refills

Reauthorization is required to continue receiving assistance through this program.[2] You will need to:

• Provide updated income documentation periodically
• Confirm your continued eligibility
• Maintain your valid prescription from your doctor

The program will notify you when reauthorization is needed. Contact (844) 447-5662 if you have questions about your refill status.

Additional Support Available

Beyond medication assistance, the Together with JEMPERLI program offers:

• A dedicated Patient Navigator to provide personalized support[1]
• Help navigating insurance coverage and appeals
• Information about your medication and treatment
• Connections to independent foundations for additional financial assistance[5]

Important Disclaimer

This patient assistance program does not constitute health insurance.[2] The program is managed by the GSK Patient Access Programs Foundation, an independent 501(c)(3) charitable foundation separate from GSK. Program eligibility, terms, and conditions are subject to change. For the most current information, contact the program directly or visit the official GSK Patient Assistance website.

Contact Information

Phone: (844) 447-5662[8]

For more information: Visit Together with JEMPERLI or contact your healthcare provider.