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Get started with enrollment.
Together with BLENREP offers a range of assistance options at no cost to you, but first, you and your healthcare provider need to complete enrollment. Enroll online or download the form, complete it, and submit it to your healthcare provider.
Option 1. Start enrollment online
Step 1. Click
Click the button below, and fill out the electronic form to the best of your ability. Your healthcare provider can answer any additional questions you may have.
Step 2. Sign
Complete and sign the enrollment form electronically.
Step 3. Confirm
Confirm all required fields are completed. Your healthcare provider will then be notified to provide additional information to finalize your enrollment.
Option 2. Print and fill out the form
Step 1. Download the form
Click the button below to print the enrollment form and bring it to your appointment.
Step 2. Sign
Fill and sign the enrollment form to the best of your ability and remind your healthcare provider to complete their portion of the enrollment form.
Step 3. Submit
Confirm all required fields are completed and have your healthcare provider submit the enrollment form.
What happens after I enroll? A Nurse Navigator* will help with:
Insurance coverage
Questions about insurance benefits and out-of-pocket costs? Your Nurse Navigator will help you understand whether BLENREP may be covered by insurance and your portion of the cost.†
Coordination of care
Your Nurse Navigator can help you find an infusion site or an eye doctor in your area and can answer questions about what to expect with BLENREP.
Financial assistance
Whether you’re covered by insurance or not, there are options available for which you may be eligible.
Support and education
Expect follow-up communications to receive ongoing support throughout your treatment journey.
*The Nurse Navigator does not provide medical advice and is not a part of your doctor’s care team. Please ask your doctor any questions that you might have about your disease and treatment with BLENREP.
†The information provided by Together with BLENREP is not a guarantee of coverage or payment.
Any questions? Contact us.
You can reach your Nurse Navigator at 1-844-4GSK-ONC (844-447-5662)
Monday–Friday: 8:00 AM – 8:00 PM ET