Information and resources to help start your patients

Information and resources to help start your patients on BENLYSTA.


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Determine your patient’s
insurance coverage for

Determine your patient’s insurance coverage for BENLYSTA.


    Utilize the Coverage and Formulary tool to review local coverage for your patients.

    For additional support, BENLYSTA Gateway can assist with 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. The information provided by BENLYSTA Gateway is not a guarantee of coverage.* Providers should confirm coverage information with payers.

    * Covered under a patient’s medical benefit or pharmacy benefit. Covered means any potential for reimbursement from
    a health plan and may include step edits, prior authorizations, and other restrictions based on an analysis of formal
    coverage policies.

    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.

    See Terms and Conditions for additional information.

    Learn more about the Program

    BENLYSTA Gateway

    BENLYSTA Gateway form for Patients (English)

    BENLYSTA Gateway form for Patients (Spanish)

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Evaluate which financial assistance programs are right for your patients.

Evaluate which financial assistance programs are right
for your patients.


    BENLYSTA could help with financial support

    The BENLYSTA Copay Program helps eligible commercially insured patients with their eligible out-of-pocket costs for BENLYSTA. Eligibility for the BENLYSTA Copay Program must be determined by the GSK Copay Program. Eligibility restrictions and program maximums apply. Visit for complete Program Terms and Conditions.

    The information provided by BENLYSTA Gateway is not a guarantee of eligibility.

    BENLYSTA Gateway can evaluate eligibility for the BENLYSTA Copay Program and provide general information about coverage and out-of-pocket costs through completion of a benefit investigation on behalf of the patient (see section above).

    Who may be eligible?

    Patients who:

    • Have a commercial medical or prescription insurance plan
    • Are residents of the US (including the District of Columbia, Puerto Rico, and the US Virgin Islands)
    • Are not eligible for or enrolled in a government funded program that provides prescription drug coverage

    * Patients are not eligible for this program if they are covered by any federal or state prescription insurance program. This includes patients enrolled in Medicare Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD) programs, or TriCare. This may also include state pharmaceutical assistance programs and other federal or state plans not listed. Patients are also ineligible for this program if they are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. Patients enrolled in a state or federally funded prescription insurance program may not use this program even if they seek to be processed as an uninsured (cash paying) patient. Those on Medicare Part D, even if in the coverage gap, are not eligible. Patients enrolled in private indemnity or HMO insurance plans that reimburse them for the entire cost of their prescription drugs are also not eligible.

    Additional program rules apply. Visit for complete Program Terms and Conditions.

    In-network Specialty Pharmacy may initiate copay application by patient request with BENLYSTA Gateway.

    Learn more about the Copay Program

    BENLYSTA Copay Program

    Patient Assistance Program

    BENLYSTA Gateway can help eligible uninsured patients and some
    Medicare patients who meet eligibility requirements obtain access to BENLYSTA free of charge through GSK's Patient Assistance Program. The information provided by BENLYSTA Gateway is not a guarantee of eligibility.

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BENLYSTA is available through a variety of options.


    Ordering BENLYSTA

    BENLYSTA can be ordered through Specialty Distributors or wholesalers. Clinics
    can contact one of the approved Specialty Distributors below.

    1. Specialty Distributor:

    • ASD Specialty Healthcare 1-800-746-6273
    • Besse Medical 1-800-543-2111
    • Cardinal Health Specialty 1-866-476-1340
    • CuraScript 1-800-942-5999
    • McKesson Specialty 1-800-482-6700
    • McKesson Medical-Surgical 1-800-446-3008
    • McKesson Plasma and Biologics 1-877-625-2566
    • Metro-Medical Supply, Inc (Cardinal) 1-800-768-2002
    • Oncology Supply 1-800-633-7555

    2. Wholesaler: All GSK-authorized wholesalers are eligible to access BENLYSTA provided they service eligible customer classes of trade.

    How to Order Guide (English)

    • List of distributors and Specialty Pharmacies that work with BENLYSTA.

    Acquisition through Specialty Pharmacies

    In-network Specialty Pharmacies include:

    • AcariaHealth 1-800-511-5144
    • Accredo Health Group, Inc. 1-877-ACCREDO (1-877-222-7336)
    • AllianceRx Walgreens-Prime 1-888-347-3416
    • Amber Specialty Pharmacy 1-888-370-1724
    • CVS Specialty Pharmacy 1-800-237-2767
    • Humana Specialty Pharmacy, Inc. (Humana) 1-800-486-2668
    • Kroger Specialty Pharmacy LA, LLC 1-888-355-4191
    • Magellan Rx Pharmacy 1-866-554-2673
    • Meijer Specialty Pharmacy/RxBiotech 1-855-263-4537
    • Optum® Specialty Pharmacy 1-855-427-4682
    • Reliance Rx (Specialty Pharmacy Management, LLC) 1-800-809-4763
    • SenderraRx 1-855-460-7928
    • US Bioservices 1-888-518-7246

    Specialty Pharmacy providers:

    BENLYSTA is available from the Specialty Pharmacies listed above. The payer may require that
    the patient use a particular Specialty Pharmacy. Contact the payer for information about
    preferred or mandated Specialty Pharmacies.

    In addition, BENLYSTA Gateway may be able to provide information about the payer’s

    If BENLYSTA is acquired through the Specialty Pharmacy, BENLYSTA Gateway can work with
    the Specialty Pharmacy by

    • Triaging prescription to in-network Specialty Pharmacy
    • Triaging co-pay information to the Specialty Pharmacy
    • Working with Specialty Pharmacies to provide status of enrolled patients

    Trademarks are property of their respective owners.

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Resources and information on billing and coding for BENLYSTA.


    Billing and coding support

    Physician office and hospital outpatient department

    BENLYSTA Gateway can provide information about relevant codes for BENLYSTA, including product codes, procedure codes, NDC numbers, and revenue codes. Coding preferences and requirements are dependent on payer type and plan type.

    The information provided by BENLYSTA Gateway is not a guarantee of reimbursement.

    Appeals research support

    If a patient is denied coverage for BENLYSTA, BENLYSTA Gateway can help identify the steps that practices can take to appeal claims. BENLYSTA Gateway cannot author appeal letters on behalf of physicians. See sample letter of appeal below.

    Sample forms and letters

    If you need more information on appeal letters or letters of medical necessity, please see the examples of each provided below.

    Sample Letter of Medical Necessity

    Sample Letter of Appeal

    Find more billing and coding resources

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Visit for tools and resources for your
patients as they get started with BENLYSTA.

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