AIDS Treatment Data Network
611
Broadway, Suite 613, New York, NY, 10012 • www.atdn.org • Tel: (212) 260-8868 • (NYS) 800-734-7104
| The Access Project collects and distributes information about medications available for HIV/AIDS and hepatitis co-infection through Medicaid, Medicare Part D, AIDS Drug Assistance Programs (ADAPs), and pharmaceutical industry sponsored patient assistance and expanded access programs (EAP). The Access Project is a program of the The Network (network@atdn.org) |
GlaxoSmithKline
Bridges To Access
Program Products
covered:
Advair (fluticasone)
Agenerase (amprenavir)
Albenza (albendazole)
Amoxil/Augmentin
(amoxicillin/clavulante potassium)
Avandamet/Avandia
(rosiglitazone maleate and metaformin)
Avodart
(dutasteride)
Bactroban (mupirocin)
Beconase
(beclomethasone)
Ceftin (cefuroxime)
Combivir
(zidovudine/lamivudine)
Compazin (prochlorperazine)
Cutivate (fluticasone)
Daraprim
(pyrimethamine)
Dexedrine (dextroamphetamine)
Emgel (erythromycin)
Epivir/Epivir HBV
(lamivudine, 3TC)
Eskalith (lithium carbonate)
Flonase/Flovent (fluticasone)
Fortaz
(ceftazidime)
Imitrex (sumatriptan)
Lamictal
(lamotrigine)
Lanoxin (digoxin)
Lotronex
(alosetron)
Malarone (atovaquone and proguanil)
Mepron (atovanquin)
Oxistat (oxiconazole)
Parnate (tranylcypromine)
Paxil (paroxetine
hydrochloride)
Relafen (nabumetone)
Relenza
(zanamivir)
Requip (ropinirole )
Retrovir
(zidovudine, AZT, ZDV)
Serevent (salmeterol
xinafoate)
Stelazine (trifluoperazine)
Tagamet
(cimetidine)
Temovate (clobetasol)
Timentin
(ticarcillin disodium and clavulanate potassium)
Trizivir
(abacavir/zidovudine/lamivudine)
Valtrex
(valaciclovir)
Ventolin (albuterol)
Wellbutrin/Zyban (bupropion)
Zantac
(ranitidine)
Ziagen (abacavir)
Zinacef
(cefuroxime)
Zofran (ondansetron)
Zovirax
(acyclovir)
| Contact
| 1-866-PATIENT
(1-866-728-4368)
http://
bridgestoaccess.gsk.com |
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| Program Eligibility |
The patient must meet
the following criteria to qualify: - Be an U. S. Resident.
- Has no health insurance or no prescription coverage.
- Not
eligible for Medicaid, ADAP, or other drug assistance programs.
- Annual income is below $25,000 for an individual, or 250% of the
Federal Poverty Level for a
family.
|
| Enrollment Process
|
Pre-Enrollment
Enrollment forms are available on the
above website or by phone or fax. An Advocate (Physician, nurse,
case worker, or someone in the doctor's office) must apply on the
patient's behalf.
The Patient and the doctor must both
complete the enrollment form, including all required signatures, and
call Bridges to Access (1-866-PATIENT) to enroll.
Enrollment
Patient eligibility is determined during the
initial phone call. The identification number on the enrollment form
is activated if the Patient is eligible.
If approved during the phone call, the Patient can take the coupon
with a prescription to any retail pharmacy to receive up to a 60-day
supply of the prescribed medicine for a $5 co-pay per drug per fill.
The enrollment form and appropriate documentation and a
prescription must be mailed to the program within 20 days of the
enrollment phone call to ensure the Patient receives refills, if
needed, by mail order in a timely manner.
Post-Enrollment
After the enrollment form and necessary
documentation are processed, the Patient can be authorized for up to
two additional 90-day supplies of medicine that the Advocate will
receive by mail. If the Patient remains active in the program,
approximately two weeks before the first 90-day medicine supply is
finished, the Advocate must call the toll-free number
(1-866-PATIENT) to request the next 90-day shipment of medicine to
be sent.
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| Re-Application
|
The enrollment is good for six months and can be extended to 12
months if needed. At the end of the first six months, the Advocate
will receive a form to reauthorize for the second six-month period.
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| Comments
|
The application process
can take some time before the patient can get the drug, healthcare
providers should apply well in advanced of the time when the patient
needs the drug. This program is to be used strictly as the "last
resort".
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