Trelegy Ellipta

Indicated For

COPD, asthma

About This Medication

# GSK Patient Assistance Program Guide: How to Get Trelegy Ellipta at Low or No Cost ## About This Program The GSK Patient Assistance Program helps eligible patients who cannot afford their medications get Trelegy Ellipta at reduced or no cost. Trelegy Ellipta is an inhaled maintenance medication used to treat chronic obstructive pulmonary disease (COPD) and asthma. It combines three active ingredients: fluticasone furoate (an inhaled corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-adrenergic agonist). ## Who Can Apply? You may qualify for the GSK Patient Assistance Program if you meet these requirements: - You are a U.S. resident - You have a valid prescription for Trelegy Ellipta from your healthcare provider - You are **uninsured** or enrolled in **Medicare** - You are **not** enrolled in any other patient assistance or drug subsidy program - Your household income falls within the program's guidelines (see income table below) - You can provide proof of residency and income ## Income Eligibility The GSK Patient Assistance Program uses income thresholds that vary based on household size. While the exact income limits can vary, here is a typical income guideline table: | Household Size | Maximum Annual Income | |---|---| | 1 person | Varies | | 2 people | Varies | | 3 people | Varies | | 4 people | Varies | | 5+ people | Varies | **Note:** Income limits are adjusted periodically and may change. Contact GSK at **(866) 728-4368** for current income thresholds specific to your household size. ## Insurance Requirements This program is available to patients who are: - **Uninsured** (no health insurance coverage), OR - **Medicare beneficiaries** (including Medicare Part D) If you have private insurance or Medicaid, you may not be eligible for this program. However, GSK also offers a **Savings Card** that may help reduce your out-of-pocket costs—visit https://www.trelegy.com/savings-and-support/ for details. ## Documents You'll Need Before applying, gather these required documents: 1. **Completed enrollment application form** (provided by GSK) 2. **Valid prescription** from your doctor for Trelegy Ellipta 3. **Proof of residency** (utility bill, lease agreement, or bank statement from the past 60 days) 4. **Proof of income** (recent tax return, pay stub, Social Security statement, or other income documentation) 5. **Photo ID** (driver's license or government-issued ID) ## How to Apply: Step-by-Step Instructions ### Step 1: Gather Your Documents Collect all required documents listed above. Make copies if you prefer to keep originals. ### Step 2: Choose Your Application Method You can apply in multiple ways: - **Online:** Visit https://gskforyou.com/programs/patient-assistance-program/ - **Phone:** Call **(866) 728-4368** to request an application or apply by phone - **Fax:** Send completed forms to **(855) 474-3063** - **Mail:** Request a paper application by calling the phone number above ### Step 3: Complete the Application Form Fill out the enrollment application completely and accurately. Include: - Your personal information (name, date of birth, contact details) - Household size and annual income - Insurance status - Your doctor's information and prescription details ### Step 4: Submit Your Application Submit your completed application along with copies of your required documents using your chosen method (online, phone, fax, or mail). ### Step 5: Wait for Approval GSK will review your application. Processing typically takes **up to 12 months for refills** once you're enrolled. Your initial application may be processed sooner—contact GSK to confirm expected timelines. ### Step 6: Receive Your Medication Once approved, Trelegy Ellipta will be **shipped directly to your pharmacy**. You'll pick it up at your local pharmacy at no cost or reduced cost, depending on your eligibility. ## Timeline and Delivery - **Application processing:** Contact GSK for estimated timeframe on initial applications - **Refill processing:** Up to 12 months for refills once enrolled - **Delivery method:** Shipped to your designated pharmacy for patient pickup - **Reauthorization:** You must reapply **annually** to continue receiving assistance ## What If Your Application Is Denied? If you're denied, you have several options: 1. **Ask why you were denied** – Contact GSK to understand the reason. You may be able to reapply if circumstances change. 2. **Try the GSK Savings Card** – Even if you don't qualify for the assistance program, you may save money using the Trelegy Ellipta Savings Card at https://www.trelegy.com/savings-and-support/ 3. **Explore other resources:** - Contact your state's pharmaceutical assistance program - Visit NeedyMeds.org for local and national assistance programs - Ask your doctor about alternative medications that may be more affordable - Check if you qualify for Medicaid in your state ## Annual Reauthorization Your assistance is not automatic every year. You **must reauthorize annually** to continue receiving medication through this program. GSK will notify you when it's time to renew. Gather updated income and residency documentation and submit your reauthorization form before your current assistance expires. ## Contact Information - **Phone:** (866) 728-4368 - **Fax:** (855) 474-3063 - **Website:** https://gskforyou.com/programs/patient-assistance-program/ - **Savings Card:** https://www.trelegy.com/savings-and-support/ ## Important Disclaimers - This program is provided by GlaxoSmithKline (GSK) and is subject to change at any time. - Eligibility requirements and income thresholds may vary and are updated periodically. - This guide is for informational purposes only and does not constitute medical or legal advice. - Always consult with your healthcare provider about your treatment options and medication needs. - Enrollment in this program does not guarantee long-term assistance; annual reauthorization is required. - If you are enrolled in other pharmaceutical assistance programs, you may not be eligible for this program. ## Questions? Don't hesitate to reach out. GSK's Patient Assistance Program staff can answer your questions about eligibility, the application process, and your status. **Call: (866) 728-4368**

Program information last verified: March 25, 2026