1-844-588-3288 (toll free) Mon-Fri, 8AM-8PM (ET)

Patient Assistance Program (PAP)*

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

Enrolled in PAP and need a prescription refill?

Order Refills Here

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

Enrolled in PAP and need a prescription refill?

Order Refills Here

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

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, and
  • Have a household income less than or equal to 500% of the Federal Poverty Level based on household size, and
  • Not be eligible for Medicaid or Puerto Rico's Government Health Plan, Mi Salud

And either:

  • Have no prescription drug coverage (unless benefits are limited to generic-only coverage: outpatient use only), or
  • Have Medicare Part D and have spent $600 or more on out-of-pocket prescription expenses during the current calendar year

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.

PAP Frequently Asked Questions

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.

For example: PAP requires that patients who need to apply for same-day access to their medicines work through a Patient Representative to enroll in ViiVConnect and apply to the ViiV Healthcare PAP over the phone.

NOTE: Same-day access service is not available for Medicare Part D patients.

How can Patient Representatives help patients apply for PAP?

A Patient Representative can help patients:

  • Enroll in ViiVConnect and apply for PAP
  • If you are a Patient Representative,* you can help your patient apply for PAP through the ViiVConnect Portal*
    Register Now or Sign In
  • Apply for same-day access to ViiV Healthcare medicine(s) by phone (not available for Medicare Part D patients)
  • Submit documentation on the patient’s behalf
  • Order refills if a valid prescription is on file
  • Look up a patient’s prescription number
  • Help a patient 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.

    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.
  • 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

What if multiple medicines from different drug companies are prescribed?

Doctors may prescribe a combination of medicines. This can be challenging if prescriptions involve multiple drug companies. If a patient needs assistance from more than one pharmaceutical company, a combined application form called the Common Patient Assistance Program Application (CPAPA) is available.

CPAPA is a single application form to apply for assistance for multiple medicines from ViiV Healthcare, as well as from other drug companies. Instead of filing multiple applications to various companies, you can file this form with all of the companies. If you need help filling out the form, you can call ViiVConnect or download the CPAPA Companion Guide for additional explanation about CPAPA and how to complete it.

Once enrolled, how do patients get medication(s)?

Same-Day Retail Pharmacy Access
Once a Patient Representative successfully enrolls a patient in PAP* over the phone, the first prescription can be picked up at a retail pharmacy for immediate access to prescribed ViiV Healthcare medicine(s).

Patients will need to bring a valid prescription for each 30-day supply of ViiV Healthcare medicine to the pharmacy.

NOTES:

  • Patients who meet eligibility requirements and are in immediate need of their ViiV Healthcare medicine(s) may get up to three 30-day retail pharmacy fills with a prescription. Patients are required to supply a 30-day prescription for each retail fill needed, and can work with a Patient Representative to submit a completed program enrollment form in parallel. Please contact ViiVConnect to speak with an Access Coordinator with any questions.

  • Over the next 30-90 days, supporting documentation will be reviewed. Once a patient has been accepted into the ViiV Healthcare PAP, the medicine supply will arrive through the mail-order pharmacy as a 90-day supply if medically appropriate, and the patient or the Patient Representative will continue to receive it through mail order throughout the program. Patients will no longer be able to pick up the medication at a retail pharmacy.

*Subject to eligibility, program terms and conditions.

Mail Order Pharmacy Access
ViiV Healthcare medications supplied through PAP are typically mailed to the patient or the Patient Representative directly.

In order for the patient to receive ViiV Healthcare medication by mail, we must receive and approve:

  1. Completed and Signed Enrollment Form.
  2. Signed Prescription. Signed original prescription(s) for ViiV Healthcare medication written for a 90-day supply with refills, if medically appropriate. Copies of prescriptions will not be accepted and will delay medication shipment.

    NOTE: Faxed prescriptions are only valid if they are faxed directly from a physician's office and accompanied by a fax cover sheet. Faxed prescriptions received from any other location will not be accepted and will delay medication shipment.

  3. Medicare Part D PAP Applicants Must Also Send*:
    • A Copy of the Medicare Part D Prescription Drug Card.
    • Proof of Spend for $600. Under the Medicare Part D rules, PAP applicants are required to show proof of spending $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 $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 D Prescription Drug 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 the patient’s total spend for the current calendar year is $600 or more – OR – the pharmacist can write in the itemized paid amounts, sign the printout, and include the pharmacy store number next to his/her signature.
        *As a reminder, submitted prescriptions and/or enrollment documentation cannot be returned.

Pharmacy Refills

Refills are mailed at no cost for up to 12 months after the patient’s enrollment into PAP.

If the patient is enrolled in PAP and needs a prescription medication refill, the patient or the Patient Representative can do one of the following:

Each refill must be requested at least 3 weeks before the existing supply of medication is completed. The prescription number is required each time a refill is requested. The prescription number can be found on the packing slip that comes with each shipment.

Phone enrollment by a Patient Representative allows non-Medicare Part D patients to receive up to three 30-day supplies of medicine through a retail pharmacy, with the first fill available that same day. The retail pharmacy fill(s) provide access to medication while the patient applies for ADAP or other coverage options and/or the patient or Patient Representative submits a completed program application and other required documents. If a patient needs assistance past the first 30-90 days, he/she will receive medication refills through mail order, when requested.

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.

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

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

  1. Completed and Signed Enrollment Form.
  2. Signed Prescription. Signed original prescription(s) for ViiV Healthcare medication written for a 90-day supply with refills, if medically appropriate. Copies of originals will not be accepted and will delay medication shipment.

    NOTE: Faxed prescriptions are only valid if they are faxed directly from a physician's office and accompanied by a fax cover sheet. Faxed prescriptions received from any other location will not be accepted and will delay medication shipment.

  3. Medicare Part D PAP Applicants Must Also Send*:
    • A Copy of the Medicare Part D Prescription Drug Card.
    • Proof of Spend for $600. Under the Medicare Part D rules, PAP applicants are required to show proof of spending $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 $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 D Prescription Drug 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 $600 or more – OR – the pharmacist can write in itemized paid amounts, sign the printout, and include the pharmacy store number next to his/her 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 right over the phone. However, in the event that income cannot be verified this way, the following describes ways to prove income.

If a patient filed income tax or was listed as a dependent on someone else's income tax for the most recently filed tax year, attach a copy of page one 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

Need Help?
Our dedicated Access Coordinators can help you determine if a patient qualifies for PAP.

phone

1-844-588-3288 (toll free)
Monday - Friday, 8AM - 8PM (ET)
Multilingual options available.

Common Patient Assistance Program Application (CPAPA)

If a patient needs assistance from more than one pharmaceutical company, then a common application form is available that can be later filed with each company.

CPAPA Form Companion Guide

Step-by-step guide for using CPAPA

For Healthcare Professionals and Patient Representatives Only

The ViiVConnect Portal
A secure online resource tool designed to help obtain patient-specific information on coverage and access to ViiV Healthcare medications.

Learn More