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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APRETUDE (cabotegravir) Enrollment Form

Enrollment form for prescribed APRETUDE

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Annotated APRETUDE Enrollment Form

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

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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 Savings Program Brochure

Quick overview of the Savings Program 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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APRETUDE Resource Holder Folder

Resource holder folder for prescribed APRETUDE

APRETUDE Savings Program Flashcard

Quick overview of the Savings Program for prescribed APRETUDE

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APRETUDE Prescription Flow Overview

Process overview from ViiVConnect enrollment to administration of prescribed APRETUDE

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Oral Savings Program Brochure

Quick overview of the Savings Program for prescribed oral ViiV Healthcare medications

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Benefit Verification

Understanding Summary of Benefits for CABENUVA

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

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Understanding Summary of Benefits for APRETUDE

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

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Acquisition Guides

CABENUVA Acquisition Guide

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

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CABENUVA Ordering Guide

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

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CABENUVA Puerto Rico Ordering Guide

In-network specialty pharmacies with contact info for prescribed CABENUVA

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CABENUVA Specialty Pharmacy Checklist

Checklist for acquiring CABENUVA through a specialty pharmacy

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CABENUVA Buy and Bill Checklist

Checklist for acquiring CABENUVA through the Buy and Bill method

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APRETUDE Acquisition Guide

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

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APRETUDE Specialty Pharmacy Checklist

Checklist for acquiring APRETUDE through a specialty pharmacy

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APRETUDE Buy and Bill Checklist

Checklist for acquiring APRETUDE through the Buy and Bill method

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APRETUDE Ordering Guide

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

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Billing, Coding, and Reimbursement

CABENUVA J-Code Flashcard

Permanent J-code established for prescribed CABENUVA

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CABENUVA Reimbursement Guide

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

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CABENUVA Billing & Coding Flashcard

Reference sheet for billing and coding for prescribed CABENUVA

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CABENUVA Prior Authorization (PA) Checklist

Guide to preparing and submitting PA requests for prescribed CABENUVA

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CABENUVA 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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CABENUVA Reimbursement Compendium Folder

Reimbursement overview for prescribed CABENUVA

APRETUDE Billing & Coding Flashcard

Reference sheet for billing and coding for prescribed APRETUDE

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APRETUDE Sample Letter of Medical Necessity

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

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APRETUDE Prior Authorization (PA) Checklist

Guide to preparing and submitting PA requests for prescribed APRETUDE

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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 Savings Program Brochure

Quick overview of the Savings Program for prescribed CABENUVA

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Spanish CABENUVA Savings Program Brochure

A quick overview of the Savings Program for prescribed CABENUVA in Spanish

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CABENUVA Savings Program Rebate Form

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

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ViiVConnect Savings Card Rebate Form

Request for a patient reimbursment check for cost associated with prescribed tablets and other dosage forms

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APRETUDE Savings Program Flashcard

Quick overview of the Savings Program for prescribed APRETUDE

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Common Patient Assistance Program Application (CPAPA)

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

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

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