About the program

GSK Vaccines Access Program is a patient assistance program sponsored by GlaxoSmithKline that provides GlaxoSmithKline vaccines to adult applicants who meet eligibility requirements. This program does not constitute health insurance

There are three easy steps to providing free vaccine to eligible patients:

  1. Prior to enrolling patients, prescribers must register in the program.
  2. For patient enrollment, prescribers must fax the completed and signed application along with the applicant’s income documentation to 1-877-822-1555. To access the application in Spanish, click here. Once approved, the applicant will be eligible to receive vaccine for up to one year.
  3. Once enrolled, the patient can receive subsequent doses of vaccine by having the prescriber complete the Dose Authorization Request Form.
Click on "Learn more" to find out how the program works


We are excited to announce the new GSK Patient Assistance Program.

Starting August 1, 2016, GSK Vaccines Access Program will transition to GSK Patient Assistance Program. On that date, there will be a few changes to better serve patients and healthcare providers:

  • A new application will be available beginning August 1, 2016. This form will be required to enroll new patients after that date and the current application will no longer be accepted. Currently enrolled patients will remain in the program for their current enrollment cycle.
  • Health and Allergy information will now be required on the application.
  • Income documentation such as tax forms will no longer be required to confirm eligibility as the program will complete automated validation of income. The program will reach out when circumstances require these forms to ensure current and accurate information has been received.
  • Updated registration numbers will be provided upon submission of the first patient application on or after August 1, 2016. No additional steps are needed to maintain program registration.
  • Applications will normally be processed within 2 business days. For immediate requests, healthcare providers should call 1-877-822-2911 for verbal processing of eligibility based on patient income and household size. This is different from the current process. If verbally approved, a prescription and attestations will be required prior to shipment.
  • Patient Care Coordinators will be available 8:00 AM to 8:00 PM Eastern Time Monday through Friday at 1-877-822-2911 to support your GSK Patient Assistance Program for Vaccines needs.

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