Patient Enrollment

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What can you do with enrollment?

Enroll patients in ViiVConnect to work with an Access Coordinator on benefit verification and savings and assistance programs* that may help patients access their prescribed ViiV Healthcare medications.

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

Enroll by Fax or Mail

Follow the instructions on the downloadable enrollment form to submit by fax or mail. The editable form can be filled in online or printed to fill in by hand. 

Watch Enrollment Video (Injections)

Enroll Online

Enroll patients digitally through the Provider Portal.

In addition to submitting electronic enrollment forms on the Provider Portal, you can also:

  • Upload documents
  • Check patient enrollment status
  • See patient coverage information
  • Receive email notifications
  • View product shipment information
  • Chat with an Access Coordinator

Prescription Claims

Sample Letter of Medical Necessity

Download our Sample Letter of Medical Necessity to see the format and types of information needed for timely prescription claim approvals.

Prior Authorization (PA) Support

Review our PA checklists or speak with an Access Coordinator for guidance on how to help minimize delays and denials of prescribed ViiV Healthcare medications.

Patient eSignature Authorization

Patients must sign the enrollment form to be eligible for ViiVConnect enrollment.  If a patient was unable to manually sign or an enrollment form was submitted without the required patient signature, patients can use this link to authorize an eSignature.

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