Rythmol SR

Indicated For

Atrial Fibrillation, Arrhythmias

About This Medication

# GSK Patient Assistance Program Patient Guide: How to Get Rythmol SR at Low or No Cost ## About This Program The **GSK Patient Assistance Program (PAP)** helps eligible patients receive certain GlaxoSmithKline prescription medicines, including Rythmol SR (propafenone HCl), at no cost.[1] This program is managed by the GSK Patient Access Programs Foundation, an independent 501(c)(3) charitable foundation separate from GSK.[1] The program does not constitute health insurance, and availability varies for each patient and product. ## About Rythmol SR Rythmol SR is a prescription antiarrhythmic medication used to treat certain heart rhythm disorders. If you have been prescribed this medication but are struggling with the cost, the GSK Patient Assistance Program may be able to help you access it at no charge. ## Who Can Qualify? You may be eligible for the GSK Patient Assistance Program if all of the following apply:[5] - You meet **financial income eligibility criteria** (at or below 250% of the Federal Poverty Level) - You are **uninsured** OR have **Medicare Part D** and meet other program requirements - You live in the **United States or Puerto Rico** - You are being treated by a **US Licensed Healthcare Provider** - You have **no prescription drug coverage** for Rythmol SR, or your coverage does not adequately address your medication needs ## Income Eligibility Breakdown The program uses income thresholds based on household size and the Federal Poverty Level (FPL). Below are the maximum annual gross income limits for 250% FPL eligibility:[9] | Household Size | Maximum Annual Gross Income (Contiguous US) | Alaska | Hawaii | |---|---|---|---| | 1 | $47,880 | $59,850 | $55,080 | | 2 | $64,920 | $81,150 | $74,670 | | 3 | $81,960 | $102,450 | $94,260 | | 4 | $99,000 | $123,750 | $113,850 | | Each additional person | +$17,040 | +$21,300 | +$19,590 | If your household has more than 4 people, add the "each additional person" amount for each extra household member. ## Insurance Requirements You are eligible if you fall into one of these categories:[5] **Uninsured Patients:** You have no health insurance coverage. **Medicare Part D Patients:** You have a Medicare prescription drug plan and have paid at least $600 out-of-pocket for prescriptions in the current calendar year.[9] **Important:** If you have private insurance that covers Rythmol SR, you may not qualify unless you can demonstrate that the medication is not covered or is unaffordable under your plan. ## How to Apply: Step-by-Step ### Step 1: Gather Required Documents Before starting your application, collect the following:[2][3] - **Completed and signed GSK Patient Assistance Program application form** - **Signed prescription** for Rythmol SR from your doctor (original or faxed directly from physician's office with cover sheet) - **Proof of income** (recent pay stubs, tax returns, or benefit statements) - **Proof of residency** (utility bill or lease agreement) - **Proof of insurance status** (insurance card, denial letter, or statement of no coverage) - **For Medicare Part D patients:** Copy of Medicare Part D ID card and Medicare Beneficiary Identifier (MBI) ### Step 2: Complete the Application You can apply in two ways: **By Phone:** Call **1-866-728-4368** to request an application form or to get assistance completing it.[5] **Online or By Mail:** Visit the GSK Patient Assistance Program website or request the application by phone. Complete all required sections of the form, including: - Your full name, date of birth, and contact information - Household size and total gross monthly or annual income - Current insurance status - The specific GSK medication(s) you need (Rythmol SR) - Any known drug allergies **Important:** An incomplete application will delay processing. Make sure every required section is filled out and the form is signed and dated.[2] ### Step 3: Submit Your Application Submit your completed application and all required documents by: - **Faxing** to the program (fax number provided on the application) - **Mailing** to the program address (provided on the application) - **Calling** 1-866-728-4368 for submission instructions **Do not send original documents**—they will not be returned. Keep copies for your records.[2] ### Step 4: Verification and Approval The program will review your application and may contact your healthcare provider or insurance company to verify information. You authorize the program to do this as part of the application process.[3] ## Timeline and Delivery While specific processing times are not publicly stated, most patient assistance programs typically process applications within 5-10 business days after all required documents are received. Once approved, Rythmol SR will be **shipped directly to you or your physician's office** at no cost to you.[1] If you do not hear back within two weeks, contact the program at **1-866-728-4368** to check on your application status. ## Prescription Refills Once you are enrolled in the program, you can request refills of your Rythmol SR by:[5] - **Calling** 1-866-728-4368 - **Visiting** the GSK Patient Assistance Program website You will need to provide your patient ID and prescription information. Refills are typically processed quickly to ensure you do not run out of medication. ## Reauthorization Your enrollment in the program may require periodic reauthorization to confirm that you still meet eligibility requirements. The program will contact you when reauthorization is needed. Be prepared to provide updated income and insurance information. ## What If Your Application Is Denied? If your application is denied, you have several options: 1. **Ask why:** Contact the program at 1-866-728-4368 to understand the specific reason for denial. Common reasons include income exceeding limits or having adequate insurance coverage. 2. **Explore other assistance programs:** GSK offers additional programs, including copay assistance for patients with insurance. Visit **GSKForYou.com** to explore other options.[7] 3. **Contact patient advocacy organizations:** Organizations like NeedyMeds, Patient Advocate Foundation, and RxAssist can help you find alternative funding sources or programs. 4. **Speak with your doctor:** Your healthcare provider may have samples, know of clinical trials, or be able to recommend more affordable alternatives. 5. **Reapply:** If your circumstances change (income decreases, insurance coverage ends), you may reapply. ## Important Disclaimers - This program does not constitute health insurance. - Eligibility and availability vary by patient and product. - Income limits and program requirements are subject to change. Always verify current eligibility criteria by calling 1-866-728-4368 or visiting the official GSK website. - This guide is for informational purposes only and does not guarantee program enrollment or medication delivery. - Residents of Puerto Rico and US Virgin Islands (for certain specialty medicines) may have different eligibility requirements. ## Contact Information **GSK Patient Assistance Program** - **Phone:** 1-866-728-4368 - **Website:** Visit GSKForYou.com or GSKPAF.org for more information - **Hours:** [Contact program for hours of operation] For questions about your specific situation, call the program directly. Representatives can help you determine eligibility, complete your application, and answer questions about the enrollment process.

Program information last verified: March 30, 2026