Provider Resources
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
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English Enrollment Form
English 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
ViiVConnect Services and Support
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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
Benefit Verification
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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
Acquisition Guides
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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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APRETUDE Puerto Rico Ordering Guide
In-network specialty pharmacies with contact info for prescribed APRETUDE
Billing, Coding, and Reimbursement
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J-Code Announcement Flashcard
Permanent J-code established for prescribed APRETUDE
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APRETUDE Reimbursement Guide
Insurance coverage and access overview, how to complete claim forms, and code reference for prescribed APRETUDE
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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 outlined 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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Electronic Prior Authorization (ePA) Brochure
Guide for submitting ePA requests through CoverMyMeds®
Getting Started For Patients
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Patient eSignature Authorization Form
Authorization form to provide an electronic signature for the enrollment form
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APRETUDE Savings Program Flashcard
Quick overview of the Savings Program for prescribed APRETUDE
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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
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English Enrollment Form
English 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
ViiVConnect Services and Support
Read more »
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
Benefit Verification
Read more »
Understanding Summary of Benefits for CABENUVA
Illustrated form highlights each section of the patient benefit summary and how to read it
Acquisition Guides
Read more »
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
Billing, Coding, and Reimbursement
Read more »
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 »
Electronic Prior Authorization (ePA) Brochure
Guide for submitting ePA requests through CoverMyMeds®
Getting Started For Patients
Read more »
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
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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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Tablets and Other Dosage Forms
Enrollment Forms
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English Enrollment Form
English enrollment form for prescribed tablets and other dosage forms
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Spanish Enrollment Form
Spanish enrollment form for prescribed tablets and other dosage forms
ViiVConnect Services and Support
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Oral Savings Program Brochure
Quick overview of the Savings Program for prescribed oral ViiV Healthcare medications
Billing, Coding, and Reimbursement
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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
Getting Started For Patients
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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
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