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viiv patient assistance form

by Eden Beatty Published 2 years ago Updated 1 year ago
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What is the ViiV Healthcare Patient Assistance Program?

The ViiV Healthcare Patient Assistance Program offers prescribed ViiV Healthcare medications at no cost to patients who qualify.* Subject to eligibility and program terms and conditions; ViiVConnect programs do not constitute health insurance. Models, not actual patients.

What is patient enrollment form viivconnect?

Patient Enrollment Form ViiVConnect is an assistance program that provides access to ViiV Healthcare medicines to eligible patients. Completion of this form can assist with information on coverage and access. There are 3 ways to enroll a patient:

How can I save on my ViiV Healthcare medications?

We offer a variety of programs to help eligible patients save on prescribed ViiV Healthcare medications. Check your eligibility by answering the questions below, or speak with an Access Coordinator about savings or assistance programs that may be available by calling 1-844-588-3288 (toll free). Subject to eligibility, program terms, and conditions.

How do I contact a ViiV Healthcare Access Coordinator?

You can reach an Access Coordinator by calling 1-844-588-3288 (toll-free) Monday-Friday, 8AM-11PM (ET). With the ViiVConnect Savings Card, eligible patients may pay as little as $0 copay per fill on select prescribed ViiV Healthcare medications.

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What is the FDA number for Viiv?from myviivcard.com

1-800-FDA-1088. The ViiVConnect Savings Card is not all that is offered at ViiVConnect. Comprehensive information on access & coverage to help you get your prescribed ViiV Healthcare medicines. A program to help eligible patients who are:

How to report side effects of prescription drugs?from myviivcard.com

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Is there an activation fee for a nda card?from myviivcard.com

TO THE PATIENT: No activation fee. This card is not valid if there are two or more A/B generic drugs available via NDA or ANDA owners (exclude repackagers). Use must be consistent with terms of your health insurer drug benefit plan. You must report your use of this card to your health insurer if required.

Is ViivConnect a health insurance?from myviivcard.com

The ViiVConnect Savings Card is not health insurance. For complete eligibility rules, click here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit fda.gov/medwatch or call. 1-800-FDA-1088. The ViiVConnect Savings Card is not all that is offered at ViiVConnect.

Is ViivConnect a savings card?from myviivcard.com

The ViiVConnect Savings Card is not all that is offered at ViiVConnect. Comprehensive information on access & coverage to help you get your prescribed ViiV Healthcare medicines

Are you a Provider?

ViiVConnect offers tools, resources, and individual assistance to healthcare professionals, pharmacists, and patient representatives. Connect with an Access Coordinator for help with benefits verification, prior authorizations, or medication reimbursement.

Are you a Patient?

Whether you’re insured, underinsured, or uninsured, find the information you need on your prescribed ViiV Healthcare medications.

Benefits of ViiVConnect for Patients

ViiVConnect helps patients explore ways to afford prescribed ViiV Healthcare medications no matter if they’re insured, underinsured, or uninsured.

Need Help?

Our Access Coordinators may be able to help you appeal a claim denial of prescribed ViiV Healthcare medications and answer other questions

How Do I Enroll?

Find out how to enroll in ViiVConnect to help you access, pay for, and receive your prescribed ViiV Healthcare medications*

How Can I Save?

Discover what savings or assistance programs may be available to help you afford your prescribed ViiV medications*

What is the FDA number for Viiv?from myviivcard.com

1-800-FDA-1088. The ViiVConnect Savings Card is not all that is offered at ViiVConnect. Comprehensive information on access & coverage to help you get your prescribed ViiV Healthcare medicines. A program to help eligible patients who are:

How to report side effects of prescription drugs?from myviivcard.com

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Are you a Provider?from viivconnect.com

ViiVConnect offers tools, resources, and individual assistance to healthcare professionals, pharmacists, and patient representatives. Connect with an Access Coordinator for help with benefits verification, prior authorizations, or medication reimbursement.

Is ViivConnect a savings card?from myviivcard.com

The ViiVConnect Savings Card is not all that is offered at ViiVConnect. Comprehensive information on access & coverage to help you get your prescribed ViiV Healthcare medicines

Is there an activation fee for a nda card?from myviivcard.com

TO THE PATIENT: No activation fee. This card is not valid if there are two or more A/B generic drugs available via NDA or ANDA owners (exclude repackagers). Use must be consistent with terms of your health insurer drug benefit plan. You must report your use of this card to your health insurer if required.

Is ViivConnect a health insurance?from myviivcard.com

The ViiVConnect Savings Card is not health insurance. For complete eligibility rules, click here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit fda.gov/medwatch or call. 1-800-FDA-1088. The ViiVConnect Savings Card is not all that is offered at ViiVConnect.

Are you a Patient?from viivconnect.com

Whether you’re insured, underinsured, or uninsured, find the information you need on your prescribed ViiV Healthcare medications.

Documents Providers Need in One Convenient Place

Our resource library is the one source where you can quickly and easily find the documents you and your patients need, including ViiVConnect enrollment forms and educational materials about ViiVConnect savings programs* and processes.

ViiVConnect Enrollment

Graphic illustration and directions on how to fill out the enrollment form for prescribed CABENUVA

ViiVConnect Services and Support

Overview of ViiVConnect services, including benefit verification, prior authorization, claim denials and appeals support, and patient savings and patient assistance programs for prescribed CABENUVA

Benefit Verification

Illustrated form highlights each section of the patient benefit summary and how to read it

Acquisition Guides

Overview of acquisition steps for prescribed CABENUVA, including Specialty Pharmacy process and Buy and Bill process

Billing, Coding, and Reimbursement

Insurance coverage and access overview, how to complete claim forms, and code reference for prescribed CABENUVA

Common Patient Assistance Program Application (CPAPA)

Common patient assistance application form when patients need assistance from more than one pharmaceutical company

STEP ONE

Patients must complete an enrollment form to connect with an Access Coordinator and apply for ViiVConnect services or programs.

STEP TWO

Access Coordinators can help patients who are insured, underinsured, and uninsured explore ways to afford prescribed medications from ViiV Healthcare.

STEP THREE

You may be notified to pick up your ViiV Healthcare medications at your pharmacy. You may also receive them in the mail at your home.

What is the phone number for Viracept?from drugs.com

Applicable drugs: Viracept (nelfinavir) More information please phone: 877-968-7233 Visit Website.

How much does a free drug card save?from drugs.com

The free Drugs.com Discount Card works like a coupon and can save you up to 80% or more off the cost of prescription medicines, over-the-counter drugs and pet prescriptions.

Do you have to be a US resident to be a patient?from drugs.com

The patient must also be a US resident.

Do you have to have a Social Security number to be a patient?from drugs.com

The patient must also be a US resident with a Social Security Number.

Is Tivicay PD a generic drug?from drugs.com

Prices are for cash paying customers only and are not valid with insurance plans. Tivicay PD is available as a brand name drug only, a generic version is not yet available. For more information, read about generic Tivicay PD availability .

What is the FDA number for Viiv?

1-800-FDA-1088. The ViiVConnect Savings Card is not all that is offered at ViiVConnect. Comprehensive information on access & coverage to help you get your prescribed ViiV Healthcare medicines. A program to help eligible patients who are:

How to report side effects of prescription drugs?

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Is ViivConnect a health insurance?

The ViiVConnect Savings Card is not health insurance. For complete eligibility rules, click here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit fda.gov/medwatch or call. 1-800-FDA-1088. The ViiVConnect Savings Card is not all that is offered at ViiVConnect.

Is there an activation fee for a nda card?

TO THE PATIENT: No activation fee. This card is not valid if there are two or more A/B generic drugs available via NDA or ANDA owners (exclude repackagers). Use must be consistent with terms of your health insurer drug benefit plan. You must report your use of this card to your health insurer if required.

What is a ViivConnect card?from dovato.com

The ViiVConnect Savings Card* offers eligible patients savings on additional costs (such as out-of-pocketcosts) not covered by insurance.

What to tell your healthcare provider about Dovato?from dovato.com

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medicines interact with DOVATO. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine.

What are the side effects of Dovato?from dovato.com

If you have both HIV-1 infection and Hepatitis B virus (HBV) infection, DOVATO can cause serious side effects, including: 1 Resistant HBV. Your healthcare provider will test you for HBV infection before you start treatment with DOVATO. If you have HIV-1 and hepatitis B, the HBV can change (mutate) during your treatment with DOVATO and become harder to treat (resistant). It is not known if DOVATO is safe and effective in people who have HIV-1 and HBV infection. 2 Worsening of HBV infection. If you have HBV infection and take DOVATO, your HBV may get worse (flare-up) if you stop taking DOVATO. A “flare-up” is when your HBV infection suddenly returns in a worse way than before.#N#Do not run out of DOVATO. Refill your prescription or talk to your healthcare provider before your DOVATO is all gone.#N#Do not stop DOVATO without first talking to your healthcare provider.#N#If you stop taking DOVATO, your healthcare provider will need to check your health often and do blood tests regularly for several months to check your liver function and monitor your HBV infection. It may be necessary to give you a medicine to treat hepatitis B. Tell your healthcare provider about any new or unusual symptoms you may have after you stop taking DOVATO.

What to tell your doctor before taking Dovato?from dovato.com

Before you take DOVATO, tell your healthcare provider about all of your medical conditions, including if you: have or have had liver problems, including hepatitis B or C infection. have kidney problems. are pregnant or plan to become pregnant. One of the medicines in DOVATO (dolutegravir) may harm your unborn baby.

How much does Dovato cost?from drugs.com

The cost for Dovato oral tablet (50 mg-300 mg) is around $2,648 for a supply of 30 tablets, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.

Can you take Dovato with Dofetilide?from dovato.com

take dofetilide. Taking DOVATO and dofetilide can cause side effects that may be serious or life-threatening.

How to report side effects of prescription drugs?from myviivcard.com

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

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