ViiVConnect Portal

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 your patient doesn't have insurance and can't afford the ViiV Healthcare medication(s) you prescribed, he/she may qualify for PAP, if he/she:

  • Lives in one of the 50 states, the District of Columbia, or Puerto Rico, and
  • Has a household income less than or equal to 500% of the Federal Poverty Level based on household size, and
  • Has no prescription drug coverage (unless benefits are limited to generic-only coverage: outpatient use only), or
  • Has Medicare Part D and spent $600 or more on out-of-pocket prescription expenses during the current calendar year, or
  • Is 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 find out if your patient qualifies for PAP?

Get Help

For Healthcare Professionals and Patient Representatives Only

The ViiVConnect Portal is designed to help Healthcare Professionals and Patient Representatives quickly obtain patient-specific information on coverage and access to ViiV Healthcare medications.

Register today for 24/7 exclusive access to the newest feature of ViiVConnect!

  • Streamlined enrollment process
  • Instantly track patient coverage status and history
  • Real-time e-mail notification alerts
  • New click-to-chat feature! Available early 2017 with enrollment, M–F, 8 AM – 8 PM (ET)
  • Easy upload of supporting documentation
  • And more!

NOTE: Patient information and data are housed in a secure online environment compliant with HIPAA laws and regulations.

  • 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 applying for same-day access to their medication 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 a patient 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 medication(s) by phone (not available for Medicare Part D patients)
    • Submit documentation on the patient's behalf
    • Order refills, if a patient needs help
    • 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.
    • 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 I prescribe multiple medications from different drug companies?

    If your patient needs to apply to more than one pharmaceutical company for assistance, he/she 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 your patients to apply for patient 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.

  • My patient is enrolled in PAP. How do we get his/her medication(s)?

    ➢ Same-Day Retail Pharmacy Access

    If your patient's 'Patient Representative' successfully enrolled him/her in PAP over the phone, patients can pick up his/her first prescription at the retail pharmacy for immediate access to the ViiV Healthcare medication(s) you prescribed.

    Our Medications

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

    ➢ Mail Order Pharmacy Access

    ViiV Healthcare medications supplied through PAP are typically mailed to you or your patient directly.

    In order for your patient to receive ViiV Healthcare medications 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 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 provide proof of spending $600 or more on out-of-pocket prescription expenses during the current calendar year.
      • Proof-of-Spend documents 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, 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 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 itemized paid amounts for the prescription medication(s) listed, ViiVConnect can call the pharmacy to verify the patient’s total spend is $600 or more in out-of-pocket prescription expenses – 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.

    ➢ Prescription Refills

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

    If your patient is enrolled in PAP and needs a prescription medication refill, you, your patient, or your patient’s 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 patient's existing supply of medication has been completed. Your patient's 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.

    If your patient enrolled by phone with the help of his/her Patient Representative and needs prescription assistance past the first 30-day period of the phone enrollment, he/she will receive refills for medication through mail order when requested.

  • Does my patient have to re-enroll in the PAP every year?

    Yes. Your patient must re-apply to PAP every year. A re-enrollment letter will be mailed to your patient or his/her Patient Representative when it is time.

    How to re-enroll each year

    Your patient or his/her 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 provide proof of spending $600 or more on out-of-pocket prescription expenses during the current calendar year.
      • Proof-of-Spend documents 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, 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 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 itemized paid amounts for the prescription medication(s) listed, ViiVConnect can call the pharmacy to verify the patient’s total spend is $600 or more in out-of-pocket prescription expenses – 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 does my patient show Proof of Income?

    Income documentation such as tax forms will no longer be required to confirm eligibility as the program will complete an online validation of the patient’s income using the patient’s name, address and date of birth. The program will reach out when circumstances require these forms to ensure current and accurate information has been received.

    If circumstances require additional proof 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.