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CABENUVA (cabotegravir 200 mg/mL; rilpivirine 300 mg/mL) EXTENDED-RELEASE INJECTABLE SUSPENSIONS: PATIENT ASSISTANCE PROGRAM (PAP)*

Photography is being used for illustrative purposes only. Stock photo. Posed by model.

The ViiV Healthcare Patient Assistance Program (PAP) offers our medicines at no cost to patients who qualify.

At ViiV Healthcare, we strive to provide an equal standard of care for all patients. If a patient doesn’t have insurance and is having trouble paying for the ViiV Healthcare medicine(s) prescribed, the patient may qualify for PAP. 

 

To be eligible for PAP, the patient MUST:

  • Live in one of the 50 states, the District of Columbia, or Puerto Rico
  • Have a household income less than or equal to 500% of the Federal Poverty Level based on household size
  • Not be eligible for Medicaid or Puerto Rico’s Government Health Plan, Mi Salud

And either: 

  • Have no prescription drug coverage,

Or:

  • Have a Medicare Part B, Medicare Part D, or Medicare Advantage Plan and have spent at least $600 or more on out-of-pocket prescription expenses during the current calendar year,

Or:

  • Have a private insurance plan limited to generic-only coverage, outpatient use only, or therapeutic class exclusion (non-coverage) of drug

NOTE: Puerto Rico applicants who qualify for Puerto Rico’s Government Health Plan must have documentation of denial of coverage through Mi Salud before applying to ViiV Healthcare PAP. 

 

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

PAP Frequently Asked Questions

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  • What is a Patient Representative?

    A Patient Representative is someone who is not a family member or friend, whom the patient has designated to act on his/her behalf for specific healthcare needs or program requirements. This could be a member of the patient’s healthcare team such as a doctor, nurse, or pharmacist; or a social worker, caseworker, or member of the clergy as designated by the patient.

  • How can Patient Representatives help patients apply for PAP?

    A Patient Representative can help patients:

    • Enroll in ViiVConnect and apply for PAP
    • Apply for PAP through the ViiVConnect Portal, Register Now, or Sign In
    • Submit documentation on the patient’s behalf
    • Look up a patient’s prescription number
    • Re-enroll each year
    • Inform ViiVConnect of any changes in prescription, address, or income
    • Follow up with a patient at intervals as needed by the program
    • Attest that a patient has no medical or prescription insurance benefits, including Medicaid, the Marketplace Exchange or other public programs, and that all information provided to the program Access Coordinator or via written application is complete, accurate, and truthful
    • Attest that they will not sell, barter, or give medication provided through the program to anyone other than the patient for whom it has been prescribed

    NOTE: Patients who do not want to or cannot provide a U.S. residential address and meet all eligibility criteria can be enrolled by a Patient Representative whose office/clinic address will serve in place of Patient Residential Address.

    *Please note that clergy can also be Patient Representatives, but they will not have access to the ViiVConnect Portal.

  • Is there a fee to apply for PAP?

    No. ViiVConnect does not charge a fee to apply for the Patient Assistance Program.

  • How do patients enroll in PAP for CABENUVA?

    When filling out the CABENUVA enrollment form, patients must fill out Section 8: PATIENT ASSISTANCE PROGRAM (PAP) to apply for medications at no cost. Don’t forget—a patient signature is required on the enrollment form. After a completed, signed enrollment form has been received, ViiVConnect may confirm PAP eligibility and notify the patient and Patient Representative, or healthcare provider.

     

  • Can Healthcare Providers/Patient Representatives help patients enroll for PAP via the ViiVConnect Portal?

    Yes. The most efficient way for Healthcare Providers/Patient Representatives to enroll patients for the Patient Assistance Program is through the ViiVConnect Portal. Complete the CABENUVA Enrollment Form in the Portal with the patient and submit the form electronically to ViiVConnect.

    When CABENUVA has been prescribed, ViiVConnect may set up the provider’s or alternative site for administration's account details in the ordering system within the Portal (if an account has not already been established), and the provider/patient representative will be assigned an account number in the ordering system. ViiVConnect may then schedule medication shipments under PAP to the injection facility.

  • Once enrolled in PAP, how do patients get their prescribed medication(s)?

    Once a patient has been successfully enrolled in PAP, the first 30-day supply of medication may be express mailed to the healthcare provider's office or, if indicated by the patient on the enrollment form, directly to the patient. Patients should also schedule their next appointment with the provider's office.

     At each visit, the provider’s office or alternative site of administration should schedule the next appointment with the patient. Upon confirmation of patients’ scheduled appointments, ViiVConnect will ship medication to the provider’s office or alternative site of administration.

  • When patients have been enrolled in PAP, how do providers acquire CABENUVA?

    When patients are enrolled in PAP and an injection appointment has been confirmed, ViiVConnect will place the CABENUVA order and arrange for shipment of medication to the healthcare provider’s office or alternative site of administration where injection will be administered. CABENUVA will arrive at least 1-2 days before the patient’s scheduled appointment, depending on the provider’s delivery preference. 

  • Do patients have to re-enroll in PAP every year?

    Yes. Patients must re-apply to PAP every year. A re-enrollment letter will be mailed to the patient and/or the patient’s healthcare provider and/or Patient Representative when it is time.

    For non-Medicare patients, re-enrollment is required one year from the date of the patient’s PAP enrollment (not based on the calendar year).

    For Medicare Part B, Medicare Part D, or Medicare Advantage patients, PAP eligibility is based on the calendar year. Enrollment in PAP will expire on December 31 of the current year, and patients will not be able to use PAP again until program enrollment is confirmed in the new calendar year.

  • How do patients re-enroll in PAP each year?

    The patient or Patient Representative will need to submit the following documentation to ViiVConnect:

    1. Completed and signed CABENUVA enrollment form.

    2. Medicare Part B, Medicare Part D, and Medicare Advantage PAP applicants must also send*:

    • A copy of the Medicare Part B, Medicare Part D, or Medicare Advantage Plan insurance card
    • Proof of spend for at least $600. Under Medicare Part B, Medicare Part D, and Medicare Advantage rules, PAP applicants are required to show proof of spending at least $600 or more on out-of-pocket prescription expenses during the current calendar year
    • Proof-of-spend documentation must meet the following criteria:
      • Patient’s name printed as part of the document. Handwritten names will not be accepted
      • All out-of-pocket prescription expenses must be itemized and total at least $600 or more for the current calendar year. This includes all prescriptions filled in the current calendar year, not just ViiV Healthcare medication(s)

    NOTE: Monthly insurance Premiums, other medical expenses, and prescription expenses for other household/family members do not count toward the $600 minimum proof-of-spend requirements.

    • Acceptable proof-of-spend documentation includes:
      • Most recent explanation of benefits from the patient’s Medicare Part B, Medicare Part D, or Medicare Advantage Plan
      • Printout from the pharmacy itemizing all prescription expenses for the current calendar year. Printouts must include itemized paid amounts

    NOTE: If the pharmacy printout does not include all itemized, out-of-pocket prescription expenses, ViiVConnect can call the pharmacy to verify total spend for the current calendar year is at least $600 or more, OR the pharmacist can write in itemized paid amounts, sign the printout, and include the pharmacy store number next to their signature.

    *As a reminder, submitted prescriptions and/or enrollment documentation cannot be returned.

  • How do patients show Proof of Income if ViiVConnect has specifically requested documentation?

    In many cases, an Access Coordinator will be able to verify income electronically as part of the PAP eligibility review process. However, in the event that income cannot be verified this way, the following describes ways to prove income:

    • If a patient filed an income tax return or was listed as a dependent on someone else's income tax for the most recently filed tax year, attach a copy of page 1 of the tax form
    • If the patient did not file, or if the tax form does not represent current income, attach Proof of Income from all sources for the most recent 30-day period for the patient and all members of the patient’s household
    • Please provide copies, not originals, of pay stubs, unemployment stubs, Social Security statements, pension statements, and any other sources of income

    The following are examples of acceptable Proof of Income:

    Income Tax Form:

    • A copy of page 1 of the most recently filed 1040, 1040A, or 1040EZ tax return

    Salary/Wages:

    • One month of consecutive salary/income documentation
    • A copy of a pay stub with year-to-date income
    • Letter indicating salary/wages on company letterhead with the employer's handwritten signature. Letterhead must include a phone number and/or complete address
    • Notarized statement from employer
    • Bank statement showing salaries and wages deposited by employer

    Self-Employment Income:

    • 1040 form, including Schedule C from the most recent tax return

    Social Security Retirement

    • Benefit statement for current year
    • Copy of most recent bank statement showing direct deposit
    • Copy of most recent check or check stub

    Supplemental Security Income

    • Benefit statement for current year
    • Copy of most recent bank statement showing direct deposit
    • Copy of most recent check or check stub

    Social Security Disability

    • Benefit statement for current year
    • Copy of most recent bank statement showing direct deposit
    • Copy of most recent check or check stub

    Unemployment

    • Unemployment award letter on company letterhead indicating amount and time period covered
    • Copy of most recent unemployment check or unemployment check stub

    Alimony/Child Support

    • Court award letter indicating amount and time period covered
    • Child Support Enforcement Agency letter
    • Letter from attorney stating amount and time period covered
    • Copy of one month's check
    • Bank statement with amount indicated

    Veterans Benefits

    • Benefit statement for current year
    • Copy of most recent bank statement showing direct deposit
    • Copy of most recent check or check stub

    Pension/Retirement

    • Benefit statement for current year
    • Copy of most recent bank statement showing direct deposit
    • Copy of most recent check or check stub

    Other

    • Benefits statement
    • Award letter
    • Bank statement from payer/source
    • Copy of check(s)
    • Judgment statement

  • What can providers do if CABENUVA obtained through the ViiV Healthcare Patient Assistance Program needs to be returned?

    For ViiV’s Patient Assistance Program product returns, a Return Goods Authorization (RGA) is required. The RGA can be obtained by contacting the GSK Customer Service Center at 1-800-877-1158. The GSK Customer Service Center will provide next steps for return logistics along with the RGA information.     

NEED HELP? TALK ONE-ON-ONE LIVE WITH OUR ACCESS COORDINATORS   
1-844-588-3288 (toll free)

We have programs for eligible patients who are insured, underinsured, and uninsured. 
Monday - Friday, 8AM - 11PM (ET).
Multilingual options available.

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