CABENUVA (cabotegravir 200 mg/mL; rilpivirine 300 mg/mL): CABENUVA RESOURCES
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Review resources below for patients and providers to help in getting started with prescribed CABENUVA.
For Healthcare Providers
ViiVConnect Enrollment
Enrollment Form
Enrollment Form for prescribed CABENUVA
Annotated Enrollment Form
Graphic illustration and directions on how to fill out the form
Alternative Site for Administration Agreement
Agreement form for those facilities wishing to be listed as an Alternative Site for Administration
ViiVConnect Services and Support
ViiVConnect Brochure
ViiVConnect services: benefit verification, prior authorization, claim denials and appeals support, and patient savings and patient assistance programs for prescribed CABENUVA
ViiVConnect Flashcard
An abbreviated version of the ViiVConnect Brochure
Patient Savings Programs Brochure
Quick overview of the Patient Savings Programs for prescribed CABENUVA
CABENUVA Bridge Program Brochure
Detailed information about the CABENUVA Bridge Program
Benefit Verification
Understanding Summary of Benefits
Illustrated form calling out each section of the patient benefit summary and how to read it
Acquisition Guides
Acquisition Guide
Overview of acquisition steps for prescribed CABENUVA, including Specialty Pharmacy process and Buy and Bill process
Ordering Guide
In-network specialty pharmacies and distributors with contact information for prescribed CABENUVA
Specialty Pharmacy Checklist
Checklist for acquiring CABENUVA through a specialty pharmacy
Buy and Bill Checklist
Checklist for acquiring CABENUVA through the Buy and Bill method
Reimbursement, Billing and Coding
Reimbursement Guide
Insurance coverage and access overview, how to complete claim forms, and code reference for prescribed CABENUVA
Billing & Coding Flashcard
Reference sheet for billing and coding for prescribed CABENUVA
Prior Authorization (PA) Checklist
Guide to preparing and submitting prior authorization requests for prescribed CABENUVA
Sample Letter of Medical Necessity
Format and types of information needed for prescribed CABENUVA outlined in sample letter
For Patients
Getting Started
Enrollment Form
Enrollment Form for prescribed CABENUVA
Patient eSignature Authorization
Authorization form to provide an electronic signature for the enrollment form
Patient Savings Programs Brochure
Quick overview of the Patient Savings Programs for prescribed CABENUVA
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.
CBRWCNT210002
