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Get started with enrollment
When you choose to enroll in Together with BENLYSTA, you and your patient will have access to our Patient Experience Center and all that it offers. After enrollment, Together with BENLYSTA can conduct benefit verifications, provide information about the prior authorizations and appeals process, assess patient eligibility for the copay or patient assistance program, and offer specialty pharmacy triage and claims and billing support.
Help enroll your patients
Choose an option below
Start online or download and fax—whatever works best for you.
Complete and sign
Sign as marked or provide your digital signature.
Review and submit
Make sure all required fields are completed by you and your patient.
Digital e-Enrollment
You can begin your patient’s electronic enrollment into Together with BENLYSTA. This process should take approximately 5 to 10 minutes and will easily guide you through what information is needed.
Please be sure to have your patient’s email address, insurance information, and any other required information.
Other options to enroll
Enroll through the provider portal
Register your practice, enroll patients, and access program resources on the Together with BENLYSTA Provider Portal. This online support option provides e-Signature capability, status updates on enrollment form submissions, real-time notification alerts, and an option to upload supporting documentation.
Prefer a paper form?
You can download and print the enrollment form with your patient. After you complete and sign the form, you will need to fax it to Together with BENLYSTA at 1-844-237-3172 to start the process.
FOR COST SUPPORT ONLY
Only interested in copay support? We’ve got you covered.
If you have all the other details covered and your patients are interested only in cost support, you can get the process started. Use the Together with BENLYSTA Copay Program to easily have your eligible commercially insured patients consent and receive a virtual copay card.
If eligible and approved, your patient will receive an email for their consent to the program requirements. Once complete, eligible patients will receive their unique copay member information. Restrictions apply.
Frequently asked questions
We are here to help!
You can reach Together with Benlysta at 1-844-225-5894 (844-Call-TwGSK).
Monday–Friday: 8:00 AM – 8:00 PM ET