Ojjaara (momelotinib)
Patient Assistance Program Guide — GSK Patient Assistance Program (GSK For You)
Do You Qualify?
Income
Up to $90,360 for a single person
Insurance
Uninsured, underinsured, or Medicare Part D patients who meet specific out-of-pocket cost requirements; commercially insured patients are typically directed to the savings card first.
Residency
U.S. resident or Puerto Rico with a valid U.S. address
Income Limits (600% FPL)
Calculated based on 600% FPL, which is standard for GSK specialty oncology and hematology medications.
Based on 2025 HHS Federal Poverty Level guidelines.
# A Patient Guide to Getting Ojjaara (Momelotinib) Through the GSK Patient Assistance Program (GSK For You)
---
Who Qualifies for the GSK Patient Assistance Program (GSK For You)?
If you have been prescribed Ojjaara (momelotinib) and cannot afford it, you may be able to get it at no cost through the GSK Patient Assistance Program, also called GSK For You. This program is run directly by GlaxoSmithKline, the company that makes Ojjaara.
To start, your household income generally needs to be at or below $90,360 per year for a single person. Higher limits apply for larger households.
For insurance, this program is designed for patients who are uninsured, underinsured, or enrolled in Medicare Part D and face significant out-of-pocket costs. If you have commercial insurance that covers Ojjaara, GSK will typically point you toward their savings card program first, rather than this assistance program.
---
About Ojjaara (Momelotinib)
Ojjaara (momelotinib) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat intermediate or high-risk myelofibrosis (MF) in adults who also have anemia. It belongs to a drug class called JAK1/JAK2 and ACVR1 inhibitors.
Myelofibrosis is a serious bone marrow disorder, and Ojjaara is a specialty medication used specifically for patients with this condition. Specialty drugs like Ojjaara are typically expensive — often costing tens of thousands of dollars per year — because of the complexity involved in developing and manufacturing them. Without insurance or financial assistance, many patients cannot afford to fill their prescription. That is exactly what programs like GSK For You are designed to help with. There are currently no FDA-approved biosimilar versions of Ojjaara available.
---
Income Eligibility: Full Breakdown
GSK For You uses income limits based on 600% of the Federal Poverty Level (FPL), which is a standard threshold GSK applies to its specialty oncology and hematology medications. Here are the current maximum annual income limits by household size:
| Household Size | Max Annual Income |
|---|---|
| 1 person | $90,360 |
| 2 persons | $122,640 |
| 3 persons | $154,920 |
| 4 persons | $187,200 |
For households larger than four people, the income limit increases further — contact GSK For You directly to confirm the limit for your household size.
Your income is typically verified using your most recent federal tax return, W-2 form, or 1099 form. Some programs also accept three months of recent pay stubs if a tax return is not available.
If your income is above these limits, you may still have options. GSK reviews applications on a case-by-case basis in some situations, and there are other assistance programs that may help — see the "Alternatives If You Don't Qualify" section below.
---
Insurance Requirements Explained
Your insurance situation determines whether you qualify for GSK For You and what path makes sense for you:
---
Step-by-Step: How to Apply
Follow these steps to apply for free Ojjaara through GSK For You:
1. Gather your required documents. You will need: (a) proof of household income, such as a tax return, W-2, or 1099; (b) a valid, current prescription for Ojjaara from your doctor; and (c) a signed Patient Authorization Form, which gives GSK permission to process your application.
2. Get the Patient Authorization Form. Your doctor's office may have this form, or you can download it from https://www.gskforyou.com/patient-assistance-programs. Make sure your doctor signs the relevant sections.
3. Choose how to apply. GSK For You accepts applications in multiple ways:
- Online: Visit https://www.gskforyou.com/ to apply directly.
- By phone: Call (866) 728-4368 to speak with a program representative.
- By fax: Send completed documents to (855) 551-7662.
4. Submit all documents together. Incomplete applications take longer to process. Double-check that your income proof, prescription, and signed authorization form are all included.
5. Wait for confirmation. After submission, GSK will review your application. Processing typically takes 2 to 5 business days.
6. Work with your care team. Your prescriber's office is often involved in the approval process, so keep them informed that you have applied.
---
What to Expect: Timeline and Delivery
Once your application is submitted, processing typically takes 2 to 5 business days. GSK For You will notify you — and often your prescriber — once your application is approved.
If approved, Ojjaara will be shipped directly to your home address. You will not need to pick it up at a pharmacy. Make sure someone is available to receive temperature-sensitive specialty medications if that applies to your shipment.
Your approval is not permanent. Annual reauthorization is required, meaning you will need to reapply and confirm that you still meet income and insurance eligibility requirements once per year. Your prescriber will also need to reconfirm the prescription at that time. Set a reminder well before your approval anniversary to avoid any gap in your supply.
---
Alternatives If You Don't Qualify
If you do not qualify for GSK For You, here are other options to explore:
1. Biosimilars: There are currently no FDA-approved biosimilar versions of Ojjaara available, so this is not an option at this time.
2. Ojjaara Savings Card: If you have commercial insurance, you may qualify for GSK's savings card program, which can lower your out-of-pocket costs significantly. Learn more at https://www.ojjaara.com/patient-support/savings-and-resources.
3. State Pharmaceutical Assistance Programs (SPAPs): Many states offer programs that help residents — especially seniors — pay for prescription medications. Eligibility and benefits vary by state. Contact your state's department of health or aging to ask about available programs.
4. NeedyMeds.org: This free, independent website maintains a database of patient assistance programs, copay assistance, and disease-specific funds that you may not be aware of. Visit https://www.needymeds.org to search by drug name or condition.
5. RX Advantages: Our team can help you identify and navigate the right program for your situation at no cost to you.
---
*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.gskforyou.com/patient-assistance-programs](https://www.gskforyou.com/patient-assistance-programs) before applying.*
---
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
Most applications are reviewed within 2 to 5 business days after GSK receives all required documents. Incomplete applications may take longer, so make sure your income proof, prescription, and signed Patient Authorization Form are all included before you submit.
Yes, Medicare Part D patients may qualify for the GSK For You Patient Assistance Program if they meet the income requirements and face significant out-of-pocket costs. This is one area where GSK For You differs from many other manufacturer assistance programs, which typically exclude Medicare patients.
Yes. The GSK For You program requires annual reauthorization. Once per year, you will need to confirm that you still meet the income and insurance eligibility requirements and provide an updated prescription from your doctor. Plan ahead so there is no gap in your medication supply.
If your income is above the published limit for your household size, you may not qualify automatically. However, it is worth contacting GSK For You directly at (866) 728-4368 to discuss your situation. You should also explore the Ojjaara savings card at https://www.ojjaara.com/patient-support/savings-and-resources and check NeedyMeds.org for other assistance options.
If approved, Ojjaara is shipped directly to your home address. You do not need to visit a pharmacy or your doctor's office to pick it up. Make sure your home address on file with GSK is current and that someone will be available to receive the shipment.
Ready to Apply for Ojjaara Assistance?
RX Advantages handles the entire GSK Patient Assistance Program (GSK For You) 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