Enrollment Steps

Female healthcare worker going over form with male patient
Female healthcare worker going over form with male patient

What to Expect During the Enrollment Process

ViiVConnect helps healthcare professionals, pharmacists, patient representatives, and patients explore ways to access prescribed ViiV Healthcare medications—whether patients are insured, underinsured, or uninsured.


Complete the Enrollment Form

To connect with an Access Coordinator and apply for ViiVConnect services or programs, you can enroll on your own, or your doctor can complete an enrollment form for you.

Download the Enrollment/Authorization Form below, fill in all required fields, and either: 

  • Email your completed form as an attachment to info@viivconnectportal.com
  • Or print and fax your completed form to 1-844-208-7676 

Your doctor can submit an electronic enrollment form for you on the Provider Portal, or they can fax/mail a paper enrollment form to ViiVConnect.

If your provider submits an enrollment form and you are not able to sign the form in person, they may ask you to add your eSignature to the enrollment form.


Connect With an Access Coordinator

Access Coordinators can help patients who are insured, underinsured, and uninsured explore ways to afford prescribed medications from ViiV Healthcare.

Access Coordinators can help patients with benefits verification and appeals support and connect patients to information on savings and assistance programs* from ViiV Healthcare.

Check your eligibility or speak with an Access Coordinator about savings or assistance programs that may be available by calling 1-844-588-3288.

Subject to eligibility, program terms and conditions. ViiVConnect programs do not constitute health insurance.


ViiV Healthcare Medication Delivery

If you will be taking a ViiV Healthcare oral medication, you may be able to pick it up at a pharmacy or receive it by mail at home.

If you will be receiving CABENUVA (cabotegravir; rilpivirine) or APRETUDE (cabotegravir), you may receive your medication at your healthcare provider's office. If your doctor tells you it would be better to receive your medication somewhere else, you can use the Alternative Site for Administration (ASA) Locator to find the right place.

If your claim for prescribed ViiV Healthcare medication is denied by your insurance provider, call 1-844-588-3288 to speak with an Access Coordinator about how to make an appeal.