*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Patient presents voucher/card to pharmacy for each refill
Patient is sent savings card to be used at pharmacy *See Additional Information section belowįDA Approved Diagnosis - See Program Website for DetailsĬall for information or inform doctor that he/she is in need Patient Access Network Foundation (PAN) Application: Contact program Provided by: Patient Access Network FoundationĮnglish, Spanish, Others By Translation Service Patient Access Network Foundation (PAN) This is a copay assistance program Deductible: Amount of health care cost (including prescriptions) that must be paid by the insured person before insurance begins to cover costs. Co-insurance: Fixed percentage of prescription cost to be paid by insured person. Good Days Program Enrollment Information Pages (pages 1 & 2) (Spanish)Ĭall for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Co-pay: Fixed amount to be paid by insured person per prescription. Good Days Program Patient Enrollment Application (pages 3-5) (Spanish) If you have any questions, please call the VEMLIDY Co-pay Coupon Program toll-free at 1-87 between the hours of 8:00 AM and 8:00 PM ET, Monday through Friday. Good Days Program Enrollment Information Pages (pages 1 & 2) The VEMLIDY Co-pay Coupon Program will cover the out-of-pocket costs of your VEMLIDY prescription up to a maximum of 5,000 per year for eligible patients with commercial insurance. Good Days Program Patient Enrollment Application (pages 3-5) Good Days Program This is a copay assistance program *IMPORTANT: Send completed CPAPA to the corresponding addresses listed for each company. This single common application allows uninsured HIV-positive individuals with low incomes to use one application to apply for multiple assistance programs. Must be residing in the US or Puerto RicoĬomplete section, sign, attach required documentsĬo-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients. Medically appropriate condition/diagnosis Biktarvy tablet (bictegravir-emtricitabine-tenofovir alafenamide).HIV Common Application: Gilead Sciences Advancing Access Gilead Advancing Access Enrollment Form (Spanish)Īdvancing Access Uninsured 24/7 Support: Contact program Advancing Access Program This program provides brand name medications at no or low cost
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