Jemperli

Indicated For

dMMR Recurrent or Advanced Endometrial Cancer, dMMR Recurrent or Advanced Solid Tumors

About This Medication

# A Patient Guide to the GSK For You Patient Assistance Program for Jemperli (dostarlimab) *Prepared by RX Advantages* --- ## Who Qualifies for the GSK For You Patient Assistance Program? If you need Jemperli (dostarlimab) and cannot afford it, you may be able to get it at no cost through the **GSK For You Patient Assistance Program**. This program is run directly by GlaxoSmithKline, the maker of Jemperli, and is designed to help patients who meet financial and insurance requirements. To qualify, your household income generally must be at or below **$90,360 per year** if you live alone. Higher limits apply for larger households. On the insurance side, this program is available to patients who are **uninsured** or who have **Medicare Part D** and meet specific financial hardship criteria. Patients with commercial (private) insurance are typically not eligible for the patient assistance program but may qualify for a separate savings card program instead. --- ## About Jemperli (dostarlimab) Jemperli (dostarlimab) is a prescription medication made by GlaxoSmithKline. It is approved by the U.S. Food and Drug Administration (FDA) to treat adults with **mismatch repair deficient (dMMR) recurrent or advanced endometrial cancer** and **dMMR recurrent or advanced solid tumors** that have progressed after prior treatment. Jemperli belongs to a drug class called PD-1 inhibitors, which are a type of monoclonal antibody used in cancer care. As a specialty biologic medication, Jemperli carries a very high list price. Without insurance or financial assistance, the out-of-pocket cost can reach tens of thousands of dollars per year, making it unaffordable for many patients. The GSK For You Patient Assistance Program exists to help close that gap. --- ## Income Eligibility: Full Breakdown The GSK For You Patient Assistance Program uses income thresholds set at **600% of the Federal Poverty Level (FPL)**. Your household size determines the income limit that applies to you. The table below shows the maximum annual income allowed for each household size: | Household Size | Maximum Annual Income | |---|---| | 1 person | $90,360 | | 2 persons | $122,640 | | 3 persons | $154,920 | | 4 persons | $187,200 | If your household is larger than four people, the income limit increases with each additional person. Contact GSK For You directly at **(866) 728-4368** to ask about the limit for your specific household size. Your income is typically verified using your **most recent federal tax return**, a **W-2 form**, or **three months of recent pay stubs**. If your income has recently changed — for example, due to job loss or reduced hours — you may be able to use current pay stubs instead of last year's tax return to reflect your actual financial situation. If your income is above the limit for your household size, you may not qualify for the free medication program. However, you may still be eligible for other forms of assistance, which are described in the "Alternatives" section below. --- ## Insurance Requirements Explained Your insurance status plays a major role in whether you qualify. Here is how the program applies to different situations: - **If you are uninsured:** You are the primary target of this program. As long as you meet the income requirements, you are likely eligible to receive Jemperli at no cost through the GSK For You Patient Assistance Program. - **If you have Medicare Part D:** You may still qualify, but only if you meet specific financial hardship criteria set by GSK. Not all Medicare Part D patients will be approved automatically. You will need to apply and let GSK review your individual situation. - **If you have private (commercial) insurance:** You are typically not eligible for the patient assistance program, regardless of your copay or coverage level. However, GSK offers a **separate savings card** for commercially insured patients. See the Alternatives section for details. - **If you have Medicaid:** Patients covered by Medicaid are generally not eligible for manufacturer patient assistance programs due to federal regulations. You should speak with your oncology care team about other options. --- ## Step-by-Step: How to Apply Follow these steps to apply for the GSK For You Patient Assistance Program: 1. **Confirm basic eligibility.** Review the income limits and insurance requirements above before starting your application to avoid unnecessary delays. 2. **Gather your documents.** You will need: proof of income (prior year tax return, W-2, or three months of pay stubs), proof of insurance status (or documentation showing you are uninsured), and a completed enrollment form with both **your signature and your prescribing physician's signature**. 3. **Choose your application method.** You can apply in one of three ways: - **Online:** Visit [https://www.gskforyou.com](https://www.gskforyou.com) to complete and submit the enrollment form electronically. - **By phone:** Call **(866) 728-4368** to speak with a program representative who can walk you through the process. - **By fax:** Fax your completed enrollment form and supporting documents to **(866) 334-4061**. 4. **Your doctor's office submits the form.** The enrollment form requires your physician's signature, so coordinate with your oncology team or ask their office staff to help complete and submit the paperwork. 5. **Wait for confirmation.** GSK For You will review your application and typically respond within **2 to 3 business days**. 6. **Keep a copy of everything.** Save copies of all documents you submit in case you need to follow up. --- ## What to Expect: Timeline and Delivery Most applications are processed within **2 to 3 business days** of submission. You or your doctor's office will receive confirmation of approval directly from GSK For You. Once approved, Jemperli is **shipped directly to your prescribing physician's office** — not to your home. Your care team will let you know when the medication has arrived and schedule your treatment accordingly. You do not need to pick up or arrange the delivery yourself. Your enrollment in the program must be **renewed annually**. Before your approval period ends, your doctor's office will typically need to resubmit updated income documentation and a new signed enrollment form to keep your benefits active without interruption. --- ## Alternatives If You Don't Qualify If you do not qualify for the patient assistance program, there are still options worth exploring: 1. **Biosimilars:** There are currently **no FDA-approved biosimilar versions** of Jemperli (dostarlimab) available in the United States, so this is not an option at this time. 2. **GSK Savings Card for insured patients:** If you have commercial insurance, you may qualify for a copay savings card that reduces your out-of-pocket cost. Visit [https://www.jemperli.com/patient/savings-and-support/](https://www.jemperli.com/patient/savings-and-support/) for details. 3. **State Pharmaceutical Assistance Programs (SPAPs):** Many states offer their own drug assistance programs, especially for seniors or people with disabilities. Ask your care team or social worker whether your state has a program that covers oncology medications. 4. **NeedyMeds.org:** This free, nonprofit database at [https://www.needymeds.org](https://www.needymeds.org) lists hundreds of assistance programs by drug name and condition. It is a useful starting point if you are exploring multiple options. --- > *This guide is for informational purposes only and does not constitute medical or legal advice. Eligibility determinations are made solely by GlaxoSmithKline. Program terms may change — verify current requirements at [https://www.jemperli.com/support](https://www.jemperli.com/support) before applying.* ---

Program information last verified: February 27, 2026