Review the steps
to help your
patients access

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BENLYSTA Gateway is here to
help you determine your
insurance coverage for


    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

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BENLYSTA Gateway can help you
and your patients
evaluate which
financial assistance programs are
right for them.


    GSK Co-Pay Program eligibility

    The BENLYSTA Co-Pay Program helps eligible commercially insured patients with their out-of-pocket costs for BENLYSTA up to $15,000 for 12 months. Eligibility for the BENLYSTA Co-Pay Program must be determined by the GSK Co-Pay Program. Eligibility restrictions and program maximums apply.

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

    BENLYSTA Gateway can evaluate eligibility for the BENLYSTA Co-Pay 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 not insured
    • Are residents of the US (including the District of Columbia, Puerto Rico, and the US Virgin Islands)

    Who is NOT eligible?

    Patients who are:

    • Eligible for Medicare or have a state-funded or federal government-funded medical or prescription insurance plan such as Medicare, Medicaid, VA, or TRICARE
    • Age 65 or older (such 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

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

    Learn more about the Co-Pay Program

    BENLYSTA Co-Pay 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, and
BENLYSTA Gateway can help to determine which
options are available for your patient.


    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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BENLYSTA Gateway can provide information about
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

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

Benlysta cares
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1-877-4-BENLYSTA (1-877-423-6597)
Monday to Friday, 8 AM to 8 PM, ET
Select option 1 for BENLYSTA Gateway