Voucher Card
NUCALA Co-pay Program for Patients with HES
Eligible approved patients can get help with out-of-pocket costs.
Pay as little as $0 for NUCALA
Restrictions apply. Go to GSKCopayPrograms.com for complete Program Terms and Conditions.
You are not eligible for the program if:
- You are enrolled in a state or federal government-funded medical or prescription insurance plan such as Medicare, Medicaid, VA, or TRICARE.
- You are eligible for Medicare and are enrolled in a government-subsidized retiree prescription drug benefit plan or an employer group waiver health plan. (Most patients become eligible for Medicare when they reach age 65.)
- You are enrolled in a commercial health plan that does not permit the use of co-pay assistance programs.
You may be eligible for the program if:
- You have a commercial medical or prescription insurance plan; or
- You are uninsured.
AND
- You are a resident of the US (including the District of Columbia, Puerto Rico, and the US Virgin Islands).
The NUCALA Co-pay Program helps eligible approved patients with their out-of-pocket costs for NUCALA up to $15,000 for 12 months.
Your healthcare team is your first line of support when you start NUCALA. But many other resources are available to help you start and stay on your treatment with NUCALA as prescribed.
Getting Started
Restrictions apply. Go to GSKCopayPrograms.com for complete Program Terms and Conditions.
You are not eligible for the program if:
- You are enrolled in a state or federal government-funded medical or prescription insurance plan such as Medicare, Medicaid, VA, or TRICARE.
- You are eligible for Medicare and are enrolled in a government-subsidized retiree prescription drug benefit plan or an employer group waiver health plan. (Most patients become eligible for Medicare when they reach age 65.)
- You are enrolled in a commercial health plan that does not permit the use of co-pay assistance programs.
You may be eligible for the program if:
- You have a commercial medical or prescription insurance plan; or
- You are uninsured.
AND
- You are a resident of the US (including the District of Columbia, Puerto Rico, and the US Virgin Islands).
There are 2 ways to get started with the NUCALA Co-pay Program:
- You may work with your doctor to apply for the program through Gateway to NUCALA
- You may apply online at www.NUCALACopayProgram.com.
How to Use the Co-pay Program
Once you have been approved for the Co-pay Program, how you use the Co-pay Program may be different depending on how you signed up and how you pay for your medicine.
You must be approved by your insurance company to take NUCALA before you can use the Co-pay Program.
Patients in government-funded programs (eg, Medicare, Medicaid, VA, or TRICARE) are not eligible for the NUCALA Co-pay Program.
With A Specialty Pharmacy
If you take NUCALA at home OR if you receive NUCALA in your doctor’s office and your doctor chooses to use a specialty pharmacy, a specialty pharmacy will call you monthly to collect your co-pay. Follow the 2 steps below to pay your co-pay with the NUCALA $0 Co-pay Program.
Step 1:
Provide the Rx Bin, Rx Group, and Member ID numbers on your monthly $25 Voucher to the specialty pharmacy.
Once complete, your remaining out-of-pocket cost for that month will be automatically loaded onto the Virtual Debit Card.
Step 2:
Provide the number on your Virtual Debit Card to the specialty pharmacy. The Virtual Debit Card will pay for the remaining co-pay amount (up to program maximum).
You will receive a new text or email in real time, each time your Virtual Debit Card has successfully been loaded.
It is especially important that you answer this call from the specialty pharmacy and then save this phone number into your contacts, so that it may be easier to recognize when it’s time to refill your prescription.
At Your Doctor’s Office
If you receive NUCALA in your doctor’s office and your doctor chooses not to use a specialty pharmacy, your doctor’s office will collect your co-pay. Follow the 2 steps below to pay with the NUCALA $0 Co-pay Program.
If you and your doctor have worked together to complete a Gateway Enrollment Form:
Step 1:
Refer to your approval letter to understand how to activate your card with your doctor by using an Explanation of Benefits (EOB) from your insurance company.
Step 2:
Use your card each time you go to the doctor to get NUCALA.
Restrictions apply. Go to GSKCopayPrograms.com for complete Program Terms and Conditions.
You are not eligible for the program if:
- You are enrolled in a state or federal government-funded medical or prescription insurance plan such as Medicare, Medicaid, VA, or TRICARE.
- You are eligible for Medicare and are enrolled in a government-subsidized retiree prescription drug benefit plan or an employer group waiver health plan. (Most patients become eligible for Medicare when they reach age 65.)
- You are enrolled in a commercial health plan that does not permit the use of co-pay assistance programs.
You may be eligible for the program if:
- You have a commercial medical or prescription insurance plan; or
- You are uninsured.
AND
- You are a resident of the US (including the District of Columbia, Puerto Rico, and the US Virgin Islands).
OR, if you have registered directly online at www.NUCALACopayProgram.com:
Step 1:
Upload an Explanation of Benefits (EOB) to www.NUCALACopayProgram.com. (This may take up to 7 days to review, so make sure to complete in advance.)
Step 2:
After review of your EOB, you will receive a reimbursement check in the mail.
Your Card Information
Use these sample card images to help identify where your card information is located. If you have questions or need assistance along the way, please contact Gateway to NUCALA at 1-844-4-NUCALA/1-844-468-2252.
What are these cards?
These are your NUCALA Co-pay Program Voucher and Debit cards.
Once you receive your approval letter, write your co-pay information in a safe place for quick reference.
The Debit Card can help you save on the remaining balance on your NUCALA co-pay.
Virtual Debit Card
If a specialty pharmacy asks for your Voucher Card:
Wait for Your Letter
If you’re approved for the NUCALA Co-pay Program, you’ll receive an approval letter with specific instructions, tailored just for you. Make sure to follow those instructions.
Keep your cards handy, and write in your co-pay information once you receive an approval letter.
Co-pay Program Eligibility
For full terms and conditions, go to GSKCopayPrograms.com.
You are not eligible for the program if:
- You are enrolled in a state or federal government-funded medical or prescription insurance plan such as Medicare, Medicaid, VA, or TRICARE.
- You are eligible for Medicare and are enrolled in a government-subsidized retiree prescription drug benefit plan or an employer group waiver health plan. (Most patients become eligible for Medicare when they reach age 65.)
- You are enrolled in a commercial health plan that does not permit the use of co-pay assistance programs.
You may be eligible for the program if:
- You have a commercial medical or prescription insurance plan; or
- You are uninsured.
AND
- You are a resident of the US (including the District of Columbia, Puerto Rico, and the US Virgin Islands).
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