Provider Resources

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Documents Providers Need in One Convenient Place

Our resource library is the one source where you can quickly and easily find the documents you and your patients need, including ViiVConnect enrollment forms and educational materials about ViiVConnect savings programs* and processes.

 

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

ViiVConnect Enrollment

CABENUVA (cabotegravir; rilpivirine) Enrollment Form

Enrollment form for prescribed CABENUVA

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Annotated CABENUVA Enrollment Form

Graphic illustration and directions on how to fill out the enrollment form for prescribed CABENUVA

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Alternative Site for Administration Agreement

Agreement form for healthcare facilities to be listed on the ViiVConnect Alternative Site for Administration (ASA) Locator

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ViiVConnect English Enrollment Form

English enrollment form for prescribed tablets and other dosage forms

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ViiVConnect Spanish Enrollment Form

Spanish enrollment form for prescribed tablets and other dosage forms

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ViiVConnect Services and Support

ViiVConnect Brochure

Overview of ViiVConnect services, including benefit verification, prior authorization, claim denials and appeals support, and patient savings and patient assistance programs for prescribed CABENUVA

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ViiVConnect Flashcard

An abbreviated version of the ViiVConnect Brochure

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CABENUVA Patient Savings Programs Brochure

Quick overview of Patient Savings Programs for prescribed CABENUVA

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ViiVConnect Provider Portal Brochure

How to register, set up affiliations, enroll patients, submit electronic prior authorizations, and other frequently asked questions

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ViiVConnect Provider Portal Brochure Insert

Step-by-step guide for enrolling patients who have been prescribed CABENUVA

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CABENUVA Prescription Flow Overview

Process overview from ViiVConnect enrollment to administration of prescribed CABENUVA

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CABENUVA Prescription Flow for ViiVConnect Lite

Process overview for ViiVConnect Lite, an option for limited benefits verification support

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Benefit Verification

Understanding Summary of Benefits

Illustrated form highlights each section of the patient benefit summary and how to read it

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Acquisition Guides

Acquisition Guide

Overview of acquisition steps for prescribed CABENUVA, including Specialty Pharmacy process and Buy and Bill process

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Ordering Guide

Detailed information about the in-network specialty pharmacies and distributors with contact information for prescribed CABENUVA

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Puerto Rico Ordering Guide

In-network specialty pharmacies with contact info for prescribed CABENUVA

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Specialty Pharmacy Checklist

Checklist for acquiring CABENUVA through a specialty pharmacy

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Buy and Bill Checklist

Checklist for acquiring CABENUVA through the Buy and Bill method

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Billing, Coding, and Reimbursement

J-Code Flashcard

Permanent J-code established for prescribed CABENUVA

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Reimbursement Guide

Insurance coverage and access overview, how to complete claim forms, and code reference for prescribed CABENUVA

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Billing & Coding Flashcard

Reference sheet for billing and coding for prescribed CABENUVA

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Prior Authorization (PA) Checklist

Guide to preparing and submitting PA requests for prescribed CABENUVA

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Sample Letter of Medical Necessity

Format and types of information needed for prescribed ViiV medicine outlined in sample letter

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ViiVConnect Claims Portal Brochure

Summary of Portal features, functions, and the claims submission process

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Electronic Prior Authorization (ePA) Brochure

Guide for submitting ePA requests through CoverMyMeds®

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RUKOBIA (fostemsavir) PA Checklist

Guide to preparing and submitting PA requests for prescribed RUKOBIA

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Getting Started for Patients

Patient eSignature Authorization Form

Authorization form to provide an electronic signature for the enrollment form

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CABENUVA Patient Savings Programs Brochure

Quick overview of the Patient Savings Programs for prescribed CABENUVA

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CABENUVA Patient Savings Programs Rebate Form

Request for a patient reimbursement check for cost associated with precribed CABENUVA

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ViiVConnect Savings Card Rebate Form

Request for a patient reimbursement check for costs associated with precribed tablets and other dosage forms

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Spanish Patient Savings Programs Brochure

A quick overview of the Patient Savings Programs for prescribed CABENUVA in Spanish

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Common Patient Assistance Program Application (CPAPA)

CPAPA Form

Common patient assistance application form when patients need assistance from more than one pharmaceutical company

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CPAPA Guide

Use the CPAPA Guide if you need help filling out the CPAPA Form

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