OJJAARA

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

OJJAARA (momelotinib) is a prescription medicine used to treat adults with certain types of myelofibrosis (MF) who have anemia. The GSK Patient Assistance Program for OJJAARA provides the medication at no cost to eligible uninsured or functionally uninsured patients who meet income guidelines and other criteria.

About OJJAARA (Momelotinib)

OJJAARA is the first and only FDA-approved treatment specifically for adults with myelofibrosis (MF) who have anemia. Myelofibrosis is a rare blood cancer where the bone marrow doesn't produce enough healthy blood cells, often leading to anemia (low red blood cell count), fatigue, and other symptoms. OJJAARA works by inhibiting Janus kinase (JAK) enzymes, which helps reduce spleen size, improve anemia symptoms, and address the root causes of MF-related anemia.

Important Safety Information: Before starting OJJAARA, your doctor will check for infections like hepatitis B and monitor your liver enzymes monthly for the first 6 months. Possible side effects include infections, low blood cell counts, dizziness, diarrhea, and serious risks like blood clots, major cardiovascular events (heart attack, stroke), or liver problems. Always discuss risks and benefits with your healthcare provider. OJJAARA is not known to be safe or effective in children.

This program, managed by the independent GSK Patient Access Programs Foundation (a 501(c)(3) charity separate from GSK), does not constitute health insurance and is subject to eligibility, terms, and changes.

Who Qualifies?

To qualify for the GSK Patient Assistance Program for OJJAARA, you generally must:

• Be uninsured or have insurance that does not cover OJJAARA (functionally uninsured eligibility may be available—call to confirm).
• Meet income eligibility based on household size and annual gross income.
• Reside in the United States.
• Have a valid prescription for OJJAARA from a licensed provider.

Patients exceeding income limits may still qualify by showing eligible medical expenses that reduce their effective income (contact the program for details).

Income Eligibility Breakdown

Income thresholds are for uninsured patients. Medicare patients have different limits (e.g., household of 1: $71,960; add $25,320 per additional person). Always verify current guidelines by calling 1-844-760-0940.

Example: A family of 5 would have a limit of $84,000 + $12,000 = $96,000.

Insurance Requirements

This program is primarily for uninsured patients or those whose insurance does not cover OJJAARA. If you have Medicare Part D, you may be eligible under separate Medicare guidelines with adjusted income thresholds—call 1-844-4GSK-ONC (1-844-447-5662) for details. Functionally uninsured patients (e.g., high-deductible plans not covering the drug) should contact the program to check eligibility. Commercially insured patients may qualify for the separate OJJAARA Copay Program instead.

Your Patient Navigator can help verify coverage and explore options like Quick Start (for first-fill delays) or Bridge programs (for coverage gaps).

Step-by-Step Application Process

Applying is straightforward with multiple methods available. Expect 3 simple steps:

1. Discuss with Your Doctor: Confirm OJJAARA is right for you. Have your doctor complete and sign the enrollment form (download from GSKPAF OJJAARA Uninsured page).

2. Gather Required Documents:

   • Completed enrollment form with doctor signature.
   • Proof of income (e.g., tax returns, pay stubs).
   • Proof of residency and lack of insurance (if applicable).
   • Proof of eligible medical expenses (if income exceeds limits).

3. Submit Your Application:

   • Online: Visit the application URL.
   • Phone: Call 1-844-760-0940 for help enrolling or faxing forms.
   • Fax: Send to 1-844-760-0940 (for Quick Start/Bridge too).

A Patient Navigator will guide you, check insurance (if any), and provide ongoing support. Enrollment also connects you to education resources.

Timeline and Delivery

Processing time varies but aim for quick turnaround—Patient Navigators provide timely updates. Once approved, medication is shipped directly to your doctor's office or pharmacy for pickup (exact delivery method confirmed upon approval). For urgent needs, ask about Quick Start for your first prescription. Refills follow the same process; reauthorization may be needed periodically (call to confirm).

Alternatives if Denied or Ineligible

• OJJAARA Copay Program: For commercially insured patients to reduce out-of-pocket costs (up to $10,000/year max savings; Medicare/Medicaid ineligible).
• Quick Start/Bridge Programs: Free medication during coverage delays.
• Other GSK Support: Via GSKForYou.com or Together with OJJAARA.
• General Resources: RxAssist.org or PrescriberPoint for copay cards.
• No biosimilar alternatives available for OJJAARA.
• Contact your doctor for generic options or clinical trials.

If denied, appeal by providing more documentation (e.g., medical expenses) or reapply if circumstances change.

Disclaimer

This guide is for informational purposes only and based on publicly available program details as of the latest updates. Eligibility, terms, income limits, and availability can change. Programs do not guarantee coverage or payment and are not insurance. Patient Navigators do not give medical advice—consult your doctor. Verify all info by calling 1-844-760-0940 or visiting official sites. GSK and affiliates disclaim liability for decisions based on this guide.