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
Annotated APRETUDE Enrollment Form
Graphic illustration and directions on how to fill out the enrollment form for prescribed APRETUDE
Alternative Site for Administration Agreement
Agreement form for healthcare facilities to be listed on the ViiVConnect Alternative Site for Administration (ASA) Locator
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
Introduction to Access and Acquisition
A helpful guide to accessing and starting patients on a ViiV injectable product
APRETUDE Prescription Flow Overview
Process overview from ViiVConnect enrollment to administration of prescribed APRETUDE
Benefit Verification
Understanding Summary of Benefits for APRETUDE
Illustrated form highlights each section of the patient benefit summary and how to read it
Acquisition Guides
APRETUDE Acquisition Guide
Overview of acquisition steps for prescribed APRETUDE, including Specialty Pharmacy process, and Buy and Bill process
APRETUDE Ordering Guide
Detailed information about the in-network specialty pharmacies and distributors with contact information for prescribed APRETUDE
APRETUDE Puerto Rico Ordering Guide
In-network specialty pharmacies with contact info for prescribed APRETUDE
APRETUDE Puerto Rico Ordering Guide
In-network specialty pharmacies with contact info for prescribed APRETUDE
Billing, Coding, and Reimbursement
APRETUDE Reimbursement Guide
Insurance coverage and access overview, how to complete claim forms, and code reference for prescribed APRETUDE
APRETUDE Sample Letter of Medical Necessity
Format and types of information needed for prescribed ViiV medicine outlined in sample letter
APRETUDE Prior Authorization (PA) Checklist
Guide to preparing and submitting PA requests for prescribed APRETUDE
Electronic Prior Authorization (ePA) Brochure
Guide for submitting ePA requests through CoverMyMeds®
Getting Started For Patients
Patient eSignature Authorization Form
Authorization form to provide an electronic signature for the enrollment form
APRETUDE Savings Program Rebate Form
Request for a patient reimbursement check for cost associated with prescribed APRETUDE
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CABENUVA (cabotegravir; rilpivirine)
Enrollment Forms
Annotated CABENUVA Enrollment Form
Graphic illustration and directions on how to fill out the enrollment form for prescribed CABENUVA
Alternative Site for Administration Agreement
Agreement form for healthcare facilities to be listed on the ViiVConnect Alternative Site for Administration (ASA) Locator
ViiVConnect Services and Support
Introduction to Access and Acquisition
A helpful guide to accessing and starting patients on a ViiV injectable product
CABENUVA Prescription Flow Overview
Process overview from ViiVConnect enrollment to administration of prescribed CABENUVA
ViiVConnect Brochure
Overview of ViiVConnect services, including benefit verification, prior authorization, claim denials and appeals support, and patient savings and patient assistance programs
ViiVConnect Provider Portal Brochure
How to register, set up affiliations, enroll patients, submit electronic prior authorizations, and other frequently asked questions
ViiVConnect Provider Portal Brochure Insert
Step-by-step guide for enrolling patients who have been prescribed CABENUVA
Benefit Verification
Understanding Summary of Benefits for CABENUVA
Illustrated form highlights each section of the patient benefit summary and how to read it
Acquisition Guides
CABENUVA Acquisition Guide
Overview of acquisition steps for prescribed CABENUVA, including Specialty Pharmacy process, and Buy and Bill process
CABENUVA Ordering Guide
Detailed information about the in-network specialty pharmacies and distributors with contact information for prescribed CABENUVA
CABENUVA Puerto Rico Ordering Guide
In-network specialty pharmacies with contact info for prescribed CABENUVA
Billing, Coding, and Reimbursement
CABENUVA Reimbursement Guide
Insurance coverage and access overview, how to complete claim forms, and code reference for prescribed CABENUVA
CABENUVA Prior Authorization (PA) Checklist
Guide to preparing and submitting PA requests for prescribed CABENUVA
CABENUVA Sample Letter of Medical Necessity
Format and types of information needed for prescribed ViiV medicine outlined in sample letter
ViiVConnect Claims Portal Brochure
Summary of Portal features, functions, and the claims submission process
Electronic Prior Authorization (ePA) Brochure
Guide for submitting ePA requests through CoverMyMeds®
Getting Started For Patients
Patient eSignature Authorization Form
Authorization form to provide an electronic signature for the enrollment form
Spanish CABENUVA Savings Program Brochure
A quick overview of the Savings Program for prescribed CABENUVA in Spanish
CABENUVA Savings Program Rebate Form
Request for a patient reimbursement check for cost associated with prescribed CABENUVA
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Tablets and Other Dosage Forms
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
Oral Savings Program Brochure
Quick overview of the Savings Program for prescribed oral ViiV Healthcare medications
Billing, Coding, and Reimbursement
Electronic Prior Authorization (ePA) Brochure
Guide for submitting ePA requests through CoverMyMeds®
RUKOBIA (fostemsavir) PA Checklist
Guide to preparing and submitting PA requests for prescribed RUKOBIA
Getting Started For Patients
Patient eSignature Authorization Form
Authorization form to provide an electronic signature for the enrollment form
ViiVConnect Savings Card Rebate Form
Request for a patient reimbursement check for cost associated with prescribed tablets and other dosage forms
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