Jemperli (dostarlimab)
Patient Assistance Program Guide — GSK For You Patient Assistance Program
Do You Qualify?
Income
Up to $90,360 for a single person
Insurance
Available to uninsured patients or those with Medicare Part D who meet specific hardship criteria. Commercially insured patients are typically ineligible for the PAP but may qualify for the copay program.
Residency
Resident of the United States, Puerto Rico, or U.S. Virgin Islands
Income Limits (600% FPL)
Calculated based on 600% FPL, which is standard for GSK oncology patient assistance programs.
Based on 2025 HHS Federal Poverty Level guidelines.
# A Patient Guide to the GSK For You Patient Assistance Program for Jemperli (dostarlimab)
Prepared by RX Advantages
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Who Qualifies for the GSK For You Patient Assistance Program?
If you need Jemperli (dostarlimab) and cannot afford it, you may be able to get it at no cost through the GSK For You Patient Assistance Program. This program is run directly by GlaxoSmithKline, the maker of Jemperli, and is designed to help patients who meet financial and insurance requirements.
To qualify, your household income generally must be at or below $90,360 per year if you live alone. Higher limits apply for larger households. On the insurance side, this program is available to patients who are uninsured or who have Medicare Part D and meet specific financial hardship criteria. Patients with commercial (private) insurance are typically not eligible for the patient assistance program but may qualify for a separate savings card program instead.
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About Jemperli (dostarlimab)
Jemperli (dostarlimab) is a prescription medication made by GlaxoSmithKline. It is approved by the U.S. Food and Drug Administration (FDA) to treat adults with mismatch repair deficient (dMMR) recurrent or advanced endometrial cancer and dMMR recurrent or advanced solid tumors that have progressed after prior treatment. Jemperli belongs to a drug class called PD-1 inhibitors, which are a type of monoclonal antibody used in cancer care.
As a specialty biologic medication, Jemperli carries a very high list price. Without insurance or financial assistance, the out-of-pocket cost can reach tens of thousands of dollars per year, making it unaffordable for many patients. The GSK For You Patient Assistance Program exists to help close that gap.
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Income Eligibility: Full Breakdown
The GSK For You Patient Assistance Program uses income thresholds set at 600% of the Federal Poverty Level (FPL). Your household size determines the income limit that applies to you. The table below shows the maximum annual income allowed for each household size:
| Household Size | Maximum Annual Income |
|---|---|
| 1 person | $90,360 |
| 2 persons | $122,640 |
| 3 persons | $154,920 |
| 4 persons | $187,200 |
If your household is larger than four people, the income limit increases with each additional person. Contact GSK For You directly at (866) 728-4368 to ask about the limit for your specific household size.
Your income is typically verified using your most recent federal tax return, a W-2 form, or three months of recent pay stubs. If your income has recently changed — for example, due to job loss or reduced hours — you may be able to use current pay stubs instead of last year's tax return to reflect your actual financial situation.
If your income is above the limit for your household size, you may not qualify for the free medication program. However, you may still be eligible for other forms of assistance, which are described in the "Alternatives" section below.
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Insurance Requirements Explained
Your insurance status plays a major role in whether you qualify. Here is how the program applies to different situations:
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Step-by-Step: How to Apply
Follow these steps to apply for the GSK For You Patient Assistance Program:
1. Confirm basic eligibility. Review the income limits and insurance requirements above before starting your application to avoid unnecessary delays.
2. Gather your documents. You will need: proof of income (prior year tax return, W-2, or three months of pay stubs), proof of insurance status (or documentation showing you are uninsured), and a completed enrollment form with both your signature and your prescribing physician's signature.
3. Choose your application method. You can apply in one of three ways:
- Online: Visit https://www.gskforyou.com to complete and submit the enrollment form electronically.
- By phone: Call (866) 728-4368 to speak with a program representative who can walk you through the process.
- By fax: Fax your completed enrollment form and supporting documents to (866) 334-4061.
4. Your doctor's office submits the form. The enrollment form requires your physician's signature, so coordinate with your oncology team or ask their office staff to help complete and submit the paperwork.
5. Wait for confirmation. GSK For You will review your application and typically respond within 2 to 3 business days.
6. Keep a copy of everything. Save copies of all documents you submit in case you need to follow up.
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What to Expect: Timeline and Delivery
Most applications are processed within 2 to 3 business days of submission. You or your doctor's office will receive confirmation of approval directly from GSK For You. Once approved, Jemperli is shipped directly to your prescribing physician's office — not to your home. Your care team will let you know when the medication has arrived and schedule your treatment accordingly. You do not need to pick up or arrange the delivery yourself.
Your enrollment in the program must be renewed annually. Before your approval period ends, your doctor's office will typically need to resubmit updated income documentation and a new signed enrollment form to keep your benefits active without interruption.
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Alternatives If You Don't Qualify
If you do not qualify for the patient assistance program, there are still options worth exploring:
1. Biosimilars: There are currently no FDA-approved biosimilar versions of Jemperli (dostarlimab) available in the United States, so this is not an option at this time.
2. GSK Savings Card for insured patients: If you have commercial insurance, you may qualify for a copay savings card that reduces your out-of-pocket cost. Visit https://www.jemperli.com/patient/savings-and-support/ for details.
3. State Pharmaceutical Assistance Programs (SPAPs): Many states offer their own drug assistance programs, especially for seniors or people with disabilities. Ask your care team or social worker whether your state has a program that covers oncology medications.
4. NeedyMeds.org: This free, nonprofit database at https://www.needymeds.org lists hundreds of assistance programs by drug name and condition. It is a useful starting point if you are exploring multiple options.
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*This guide is for informational purposes only and does not constitute medical or legal advice. Eligibility determinations are made solely by GlaxoSmithKline. Program terms may change — verify current requirements at [https://www.jemperli.com/support](https://www.jemperli.com/support) before applying.*
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Documents You'll Need
If You Don't Qualify for the Assistance Program
Manufacturer Savings Card (for insured patients)
GlaxoSmithKline offers a savings card that may reduce your out-of-pocket cost if you have commercial insurance. Ask your prescriber or pharmacist for current savings card details.
Common Questions
The GSK For You Patient Assistance Program typically processes applications within 2 to 3 business days after receiving your completed enrollment form and all required documents. Make sure both your signature and your doctor's signature are included to avoid delays.
Yes. Many oncology practices are familiar with patient assistance programs and can help complete and submit the enrollment form on your behalf. Both your signature and your physician's signature are required on the form, so working with your doctor's office is often the easiest way to apply.
Approvals must be renewed every year. Before your current approval expires, you will need to resubmit updated income documents and a new signed enrollment form. Your doctor's office can help coordinate this process to avoid any gap in your medication supply.
No, having Medicare Part D does not automatically disqualify you. You may still be eligible if you meet specific financial hardship criteria set by GSK. You will need to apply and allow GSK For You to review your individual situation before a determination is made.
Jemperli is shipped directly to your prescribing physician's office, not to your home. This is standard for infused cancer medications. Your care team will contact you when the medication is available and schedule your treatment accordingly.
Ready to Apply for Jemperli Assistance?
RX Advantages handles the entire GSK For You Patient Assistance Program application on your behalf — paperwork, physician coordination, and refill tracking. It takes about 15 minutes to get started.
No SSN required on the web form · From $49.95/month