Patient Assistance Program (PAP)*

The ViiV Healthcare Patient Assistance Program offers our medicines at no cost to patients who qualify.
This program does not constitute health insurance.

*Subject to patient and prescription eligibility.

Need a prescription refill?
If you are enrolled in PAP and need a prescription medicine refill

Order Refills Here

At ViiV Healthcare, we strive to provide an equal standard of care for all patients. If you don’t have insurance and are having trouble paying for the ViiV Healthcare medicine(s) your doctor prescribed, you may qualify for PAP, if you:

  • 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
  • Have no prescription drug coverage (unless benefits are limited to generic-only coverage: outpatient use only), or
  • Have Medicare Part D and spent $600 or more on out-of-pocket prescription expenses during the current calendar year, or
  • Are not eligible for Medicaid or Puerto Rico's Government Health Plan, Mi Salud

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.

Want to talk to someone to find out if you may qualify for PAP?

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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.

    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 a Patient Representative help me apply for the PAP?

    A Patient Representative can help you:

    • 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 your behalf
    • Order refills, if you need help
    • Look up your prescription number
    • Help you re-enroll each year
    • Inform ViiVConnect of any changes in prescription, address, or income
    • Follow up with you at intervals as needed by the program
    • Attest that you have 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.
  • What if my doctor prescribed multiple medicines from different drug companies?

    Your doctor may prescribe a combination of medicines. This can be challenging if your prescriptions involve multiple drug companies.

    If you need to apply to more than one pharmaceutical company for assistance, you may be able to use one application called the Common Patient Assistance Program Application (CPAPA).

    CPAPA is a single application form, accepted by ViiV Healthcare, that allows you to apply for assistance for multiple medicines from one or more drug 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.

  • I am enrolled in PAP. How do I get my medicine(s)?

    ➢ Same-Day Retail Pharmacy Access

    If your Patient Representative successfully enrolled you in PAP* over the phone, you can pick up your first prescription at a retail pharmacy for immediate access to your medicine(s).

    You’ll need to bring your ViiV Healthcare Prescription for each 30-day supply of medicine, if appropriate, to the pharmacy.

    NOTE: 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. You are required to supply a 30-day prescription for each retail fill needed, and can work with your patient representative to submit your completed program enrollment form in parallel. Please contact ViiVConnect to speak with an Access Coordinator with any questions.

    Our Medicines

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

    *Subject to patient and prescription eligibility.

    ➢ Mail Order Pharmacy Access

    ViiV Healthcare medicines supplied through PAP are typically mailed to you or your Patient Representative directly.

    To receive your medicine by mail, we must receive and approve:

    1. Completed and Signed Enrollment Form.

    2. Signed Prescription. Signed original prescription(s) for ViiV Healthcare medicine written for a 90-day supply with refills, if medically appropriate. Copies of originals will not be accepted and will delay medicine 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 medicine 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, you 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:
        • Your 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 the prescriptions you have filled in the current calendar year, not just ViiV Healthcare medicine(s).
        • NOTE: Monthly insurance premiums, other medical expenses, and prescription expenses for your 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 your 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 of your itemized, out-of-pocket prescription expenses, ViiVConnect can call your pharmacy to verify your total spend for the current calendar year is $600 or more – OR – your 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.

    ➢ Prescription Refills

    Refills are mailed at no cost for up to 12 months after your enrollment has been accepted into PAP.

    If you are enrolled in PAP and need a prescription medicine refill, you or your Patient Representative can

    • Order Refills Here or,
    • Call ViiVConnect at 1-844-588-3288 (toll-free), Monday – Friday, 8 AM – 8 PM (ET).

    Each refill must be requested at least 3 weeks before your existing supply of medicine is completed. Your 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 medicine while you apply for ADAP or other coverage options and/or you or your patient representative submit your completed program application and other required documents. If you need assistance past the first 30-90 days, you will receive medicine refills through mail order, when requested.

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

    Yes. You must re-apply to PAP every year. A re-enrollment letter will be mailed to you and/or your healthcare provider and/or Patient Representative when it is time.

    ➢ How do I re-enroll in the PAP each year?

    You or your 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 medicine written for a 90-day supply with refills, if medically appropriate. Copies of originals will not be accepted and will delay medicine 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 medicine 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, you 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:
        • Your 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 the prescriptions you have filled in the current calendar year, not just ViiV Healthcare medicine(s).
        • NOTE: Monthly insurance premiums, other medical expenses, and prescription expenses for your 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 your 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 of your itemized, out-of-pocket prescription expenses, ViiVConnect can call your pharmacy to verify your total spend for the current calendar year is $600 or more – OR – your 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.

    How do I show Proof of Income if ViiVConnect has specifically requested documentation from me?

    If you filed income tax or were 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 you did not file, or if the tax form does not represent your current income, attach proof of income from all sources for the most recent 30-day period for you and all members of your 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 or 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

ViiVConnect Enrollment Form:

ViiVConnect logo

Connect with a dedicated Access Coordinator. 1-844-588-3288 (toll-free) Monday – Friday, 8 AM – 8 PM (ET). Multilingual options available.