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.

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  • APRETUDE (cabotegravir)

    Enrollment Forms

    APRETUDE 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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    Alternative Site for Administration Agreement

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

    Read more »

    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

    Read more »

    APRETUDE Savings Program Flashcard

    Quick overview of the Savings Program for prescribed APRETUDE

    Read more »

    APRETUDE Prescription Flow Overview

    Process overview from ViiVConnect enrollment to administration of prescribed APRETUDE

    Read more »

    Benefit Verification

    Understanding Summary of Benefits for APRETUDE

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

    Read more »

    Acquisition Guides

    APRETUDE Acquisition Guide

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

    Read more »

    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

    Read more »

    APRETUDE Puerto Rico Ordering Guide

    In-network specialty pharmacies with contact info for prescribed APRETUDE

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    APRETUDE Puerto Rico Ordering Guide

    In-network specialty pharmacies with contact info for prescribed APRETUDE

    Read more »

    Billing, Coding, and Reimbursement 

    J-Code Announcement Flashcard

    Permanent J-code established for prescribed APRETUDE

    Read more »

    APRETUDE Reimbursement Guide

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

    Read more »

    APRETUDE Billing & Coding Flashcard

    Reference sheet for billing and coding for prescribed APRETUDE

    Read more »

    APRETUDE Sample Letter of Medical Necessity

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

    Read more »

    APRETUDE Prior Authorization (PA) Checklist

    Guide to preparing and submitting PA requests for prescribed APRETUDE

    Read more »

    Electronic Prior Authorization (ePA) Brochure

    Guide for submitting ePA requests through CoverMyMeds®

    Read more »

    Getting Started For Patients

    Patient eSignature Authorization Form

    Authorization form to provide an electronic signature for the enrollment form

    Read more »

    APRETUDE Savings Program Flashcard

    Quick overview of the Savings Program for prescribed APRETUDE

    Read more »

    APRETUDE Savings Program Rebate Form

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

    Read more »

    CPAPA (Common Patient Assistance Program Application)

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

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

  • CABENUVA (cabotegravir; rilpivirine)

    Enrollment Forms

    pdf icon

    CABENUVA Enrollment Form

    Enrollment form for prescribed CABENUVA

    Read more »

    Annotated CABENUVA Enrollment Form

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

    Read more »

    Alternative Site for Administration Agreement

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

    Read more »

    ViiVConnect Services and Support

    CABENUVA Savings Program Brochure

    Quick overview of the Savings Program for prescribed CABENUVA

    Read more »

    CABENUVA Prescription Flow Overview

    Process overview from ViiVConnect enrollment to administration of prescribed CABENUVA

    Read more »

    ViiVConnect Brochure

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

    Read more »

    ViiVConnect Provider Portal Brochure

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

    Read more »

    ViiVConnect Provider Portal Brochure Insert

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

    Read more »

    Benefit Verification

    Understanding Summary of Benefits for CABENUVA

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

    Read more »

    Acquisition Guides

    CABENUVA Acquisition Guide

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

    Read more »

    CABENUVA Ordering Guide

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

    Read more »

    CABENUVA Puerto Rico Ordering Guide

    In-network specialty pharmacies with contact info for prescribed CABENUVA

    Read more »

    CABENUVA Specialty Pharmacy Checklist

    Checklist for acquiring CABENUVA through a specialty pharmacy

    Read more »

    CABENUVA Buy and Bill Checklist

    Checklist for acquiring CABENUVA through the Buy and Bill method

    Read more »

    Billing, Coding, and Reimbursement 

    pdf icon

    CABENUVA Reimbursement Guide

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

    Read more »

    CABENUVA Billing & Coding Flashcard

    Reference sheet for billing and coding for prescribed CABENUVA

    Read more »

    CABENUVA Prior Authorization (PA) Checklist

    Guide to preparing and submitting PA requests for prescribed CABENUVA

    Read more »

    CABENUVA Sample Letter of Medical Necessity

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

    Read more »

    ViiVConnect Claims Portal Brochure

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

    Read more »

    Electronic Prior Authorization (ePA) Brochure

    Guide for submitting ePA requests through CoverMyMeds®

    Read more »

    Getting Started For Patients

    Patient eSignature Authorization Form

    Authorization form to provide an electronic signature for the enrollment form

    Read more »

    CABENUVA Savings Program Brochure

    Quick overview of the Savings Program for prescribed CABENUVA

    Read more »

    Spanish CABENUVA Savings Program Brochure

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

    Read more »

    CABENUVA Savings Program Rebate Form

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

    Read more »

    CPAPA (Common Patient Assistance Program Application)

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

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

  • Tablets and Other Dosage Forms

    Enrollment Forms

    English Enrollment Form

    English enrollment form for prescribed tablets and other dosage forms

    Read more »

    Spanish Enrollment Form

    Spanish enrollment form for prescribed tablets and other dosage forms

    Read more »

    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

    Read more »

    Oral Savings Program Brochure

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

    Read more »

    Billing, Coding, and Reimbursement 

    Electronic Prior Authorization (ePA) Brochure

    Guide for submitting ePA requests through CoverMyMeds®

    Read more »

    RUKOBIA (fostemsavir) PA Checklist

    Guide to preparing and submitting PA requests for prescribed RUKOBIA

    Read more »

    Getting Started For Patients

    Patient eSignature Authorization Form

    Authorization form to provide an electronic signature for the enrollment form

    Read more »

    ViiVConnect Savings Card Rebate Form

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

    Read more »

    CPAPA (Common Patient Assistance Program Application)

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

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

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