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Get started with enrollment
Together with ZEJULA offers a range of assistance options at no cost to you. To take full advantage of all these services, you need to complete enrollment with help from your healthcare provider. Download the form to get started.
Here is how you can enroll
Follow these five steps to begin the enrollment process:
- Download and print the enrollment form.
- Complete all required fields on the enrollment form, including your contact information, medical and/or prescription insurance details, and your preferences.
- Ensure all required fields on the enrollment form are complete.
- Please read and sign the form; your signatures are required on the first page.
- Provide the form to your healthcare provider to complete the remaining sections. They will submit it on your behalf to Together with ZEJULA Patient Experience Center.
Once you have enrolled, a Patient Navigator from Together with ZEJULA will get in touch with you with next steps.
By enrolling, you get all the services of a Patient Navigator*
Insurance coverage
Questions about accessing ZEJULA? Your Patient Navigator can help you understand whether ZEJULA may be covered by insurance and your portion of the cost.†
Cost support
Whether you’re covered by insurance or not, there are options available for which you may be eligible.
Ongoing education
Your Patient Navigator can provide education and resources about ZEJULA, as well as ongoing support throughout your treatment journey.
*The Patient 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 ZEJULA.
†The information provided by Together with ZEJULA is not a guarantee of coverage or payment.
We are here to help!
You can reach your Patient Navigator at 1-844-4GSK-ONC (844-447-5662)
Monday–Friday: 8:00 AM – 8:00 PM ET