WHAT IS BENLYSTA GATEWAY?
BENLYSTA Gateway is available through BENLYSTA Cares. BENLYSTA Gateway helps patients and healthcare professionals understand authorization*, access, distribution, and reimbursement for BENLYSTA.
Monday-Friday, 8 AM to 8 PM, ET
BENLYSTA is available through a variety of options
- Specialty Distributor. Clinics can contact one of the approved specialty distributors below.
- ASD Specialty Healthcare
- Besse Medical (877) 728-3476
- Cardinal Health Specialty
- CuraScript (877) 599-7748
- McKesson Specialty (800) 482-6700
- McKesson Plasma and Biologics
- Metro Medical (800) 768-2002
- Oncology Supply (800) 633-7555
- ASD Specialty Healthcare
- Wholesaler. All GSK-authorized wholesalers are eligible to access BENLYSTA provided they service eligible customer classes of trade.
- Specialty Pharmacy Provider. Patients may need to use a network of Specialty Pharmacies. Please see Acquisition through Specialty Pharmacies or contact the payer for the full list of Specialty Pharmacies. The BENLYSTA Gateway or Field Reimbursement Manager (FRM) may also be able to provide assistance.
BENLYSTA Gateway can evaluate what acquisition alternatives exist based on the patient's insurance.
Should the patient be referred to an alternative site of care, contact your FRM to discuss coordination of care considerations.
ACQUISITION THROUGH SPECIALTY PHARMACIES
In-network Specialty Pharmacies include:
- Acro Pharmaceutical Services
- AcariaHealth (800) 511-5144
- Accredo Health Group, Inc.
(877) ACCREDO (222-7336)
- Aetna SP Specialty Pharmacy
- AllianceRx Walgreens-Prime
- Amber Pharmacy (888) 370-1724
- Avella (877) 546-5779
- BriovaRx (affiliate of OptumRx)
- Cigna Specialty Pharmacy (800) 351-3606
- Commcare Specialty Pharmacy
- CVS Specialty Pharmacy (800) 237-2767
- Diplomat (877) 977-9118
- Exactus Pharmacy Solutions (Wellcare)
- For Humana Pharmacy, Inc. (Humana) (800) 486-2668
- Hy-Vee Pharmacy Solutions
(877) RxHyVee (794-9833)
- Kroger Specialty Pharmacy LA, LLC
- Magellan Rx Pharmacy (866) 554-2673 - Florida; (800) 350-8119 - New York
- Meijer Specialty Pharmacy/RxBiotech
- Navarro Health Services (affiliate of CVS) (855) 647-7979
- Reliance Rx (Independent Health)
- SenderraRx (855) 460-7928
- US Bioservices (888) 518-7246
BENLYSTA Gateway can evaluate what acquisition alternatives exist based on the patient’s insurance. If BENLYSTA is acquired through the Specialty Pharmacy, BENLYSTA Gateway can work with the Specialty Pharmacy by
- Triaging prescription to in-network Specialty Pharmacy in states allowed by law
- Triaging co-pay information to the Specialty Pharmacy
- Working with Specialty Pharmacies to provide
In-network Specialty Pharmacy may initiate co-pay application by patient request with BENLYSTA Gateway.
BENEFITS INVESTIGATION AND PRIOR AUTHORIZATION (PA) RESEARCH AND SUPPORT
BENLYSTA Gateway can complete a patient-specific benefits investigation with the patient's payer† and provide PA research and support
For benefits investigation, BENLYSTA Gateway can:
- Contact insurance companies to obtain specific coverage information
- Determine whether payer requires prior authorization
- Determine estimated patient out-of-pocket responsibility
Once BENLYSTA Gateway completes a benefit verification, you and your patient will receive a Summary of Benefits that will review the patient's coverage.
†Please note that investigations do not guarantee a result, and it is the provider's responsibility to check with the payer. The patient's payer is the most accurate source of information about the patient's coverage.
For PA research and support, BENLYSTA Gateway can:
- Research plan requirements
- Outline steps required for obtaining a PA from the patient’s plan
- Obtain unique and plan-specific PA forms (where applicable)
BENLYSTA Gateway can also follow up with the plan to help determine the status of the PA submission (if requested).
Remember, BENLYSTA Gateway cannot complete PA forms or submit related information to plans. Instead, it is the responsibility of the office and prescribing physician to provide the plan with patient-specific clinical documentation.
GSK CO-PAY ASSISTANCE EVALUATION
BENLYSTA Gateway can evaluate eligibility for the BENLYSTA Co-pay Program‡
Approved patients may pay as little as $0 for BENLYSTA
Who may be eligible?
Your patients may be eligible for the Program if they:
- Have a
commercialmedical or prescription insurance plan
- Are not insured
Are aresident of the US (including the District of Columbia, Puerto Rico, and the US Virgin Islands)
Who is not eligible?
Your patients are not eligible for the Program if they are:
- Eligible for Medicare or have a state- or federal government-funded medical or prescription insurance plan such as Medicare, Medicaid, VA, or TRICARE
- Age 65 or older (patients are considered eligible for Medicare and therefore not eligible for the Co-pay Program)
- Enrolled in a commercial health plan that does not permit the use of co-pay assistance programs
BENLYSTA Gateway can help eligible uninsured and some Medicare patients who meet eligibility requirements obtain access to BENLYSTA free of charge through GSK's Patient Assistance Program.
Learn more about the Co-pay Program
BENLYSTA Gateway can also provide general information about coverage and out-of-pocket costs through completion of a
*BENLYSTA Gateway CANNOT complete prior authorization forms or submit related information directly to Payers on behalf of physician.
‡The BENLYSTA Co-pay Program helps eligible approved patients with their out-of-pocket costs for BENLYSTA up to $15,000 for 12 months. If approved, patients could pay as little as $0 for BENLYSTA. Medicare-eligible patients, and patients enrolled in government-funded programs, are not eligible for the BENLYSTA Co-pay Program. Patients must submit a BENLYSTA Gateway Enrollment Form or complete application online at benlystacopayprogram.com to determine eligibility. Click here for full Program Terms & Conditions.