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Eligibility Rules and Regulations

Subject to eligibility and restrictions. Limit 1 per person. This card is nontransferable & not valid if reproduced. This card is not health insurance.

THIS CARD MAY BE USED FOR OTHER ViiV MEDICINES. See ViiVConnect.com/medicines for the list of eligible medicines and Prescribing Information.
 

  • Savings not to exceed $7500 per year for TRIUMEQ (abacavir, dolutegravir, and lamivudine tablets), $7500 per year for RUKOBIA (fostemsavir tablets), $6250 per year for DOVATO (dolutegravir and lamivudine tablets), $6250 per year for JULUCA (dolutegravir and rilpivirine tablets), $5000 per year for TIVICAY (dolutegravir tablets), or $5000 per year for TIVICAY PD (dolutegravir tablets for oral suspension), and for other eligible ViiV Healthcare medicines not to exceed $4800 per year. Total savings not to exceed $7500 per year.
  • Present this card and, if applicable, your insurance card with your valid prescription at any participating pharmacy.

Patients who are enrolled in government healthcare prescription medicine programs are not eligible, including, without limitation, Medicare Part D, Medicaid, VA, DOD, ADAP, state pharmaceutical assistance plan, or TRICARE.

TRICARE is a registered trademark of the Department of Defense (DoD), Defense Health Agency (DHA).

Dovato

*UP TO$6250PER YEAR

with no monthly limit for DOVATO

Juluca

*UP TO $6250 PER YEAR

with no monthly limit for JULUCA

Rukobia

*UP TO $7500 PER YEAR

with no monthly limit for RUKOBIA

Triumeq

*UP TO$7500 PER YEAR

with no monthly limit for TRIUMEQ

Tivicay

*UP TO$5000 PER YEAR

with no monthly limit for TIVICAY

Tivicay PD

*UP TO $5000 PER YEAR

with no monthly limit for TIVICAY PD

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.

 

If you don't have prescription coverage, have questions about insurance coverage, or can't afford your medicines, visit ViiVConnect.com or call 1‑844‑588‑3288 for more information about financial support programs.