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Rebate Form Information
- The Rebate program is available to patients only
- If a patient pays out-of-pocket for an eligible, prescribed ViiV Healthcare medication(s) and does not utilize the ViiVConnect Savings Card, the patient can use the Rebate Form to obtain savings
- A patient is not eligible to utilize this program if they have capped out (fully utilized the maximum benefit amount) of their ViiVConnect Savings Card eligibility
Have questions? Call McKesson Corporation (McKesson), the ViiVConnect Savings Card administrator, at 1‑866‑747‑1170 to speak live to an agent.
Rebate Form Instructions
You may be eligible for reimbursement of your out-of-pocket costs if your retail or mail order pharmacy does not accept the ViiVConnect Savings Card. We offer TWO WAYS to submit your Rebate Form.
Submit Online
Submit by Postal Mail
You can download, complete, and print out the form for submission via the Postal Service.
How to Complete the Rebate Form
- Click the button below to download the Rebate Form
- Fill out the Rebate Form
- You can edit the form on your computer
- You can print the form and fill it out by hand
- Print the Rebate Form
- Enclose the form in a stamped envelope along with the following documents:
- Copy of your ViiV Healthcare prescription medication receipt
- Copy of the front and back of your insurance card
- Copy or picture of the prescription medication label, including: date of fill, name of medication, quantity, dosage strength, instructions on how to take medication, NDC, pharmacy name and location
Mail to:
DMR
PO Box 2914
Phoenix, AZ 85062-2914
When and How Will I Get My Rebate?
Once you submit the Rebate Form, medication receipt, medication label, and insurance card (via online submission or postal mail submission), you will receive a Rebate Check in the postal mail. McKesson will mail a check to the patient within 2-4 weeks.
After receiving your first Rebate Check, you will have the option of: 1) continuing to utilize postal mail for future Rebates OR 2) choosing to register for Electronic Funds Transfer (Rebate funds directly deposited into your bank account) for future Rebates. If you choose Electronic Funds Transfer, McKesson will transfer the Rebate amount to your bank account within 2-4 weeks.
Have Questions?
Call McKesson at 1-866-747-1170 to speak live to an agent.
Sample Rebate Check and Letter
PMUS-DLLWCNT240069
Things to know about the
ViiVConnect Savings Card:
Subject to eligibility. Restrictions apply. Read the full Eligibility Requirements and Restrictions.
This savings card is only available for those living in the United States and US territories.
This savings card is NOT health insurance and is NOT for people receiving primary benefits from government-funded plans.
Our ViiVConnect Access Coordinators are here to assist you. In addition to addressing any questions and needs you may have about the ViiVConnect Savings Card, they can also provide comprehensive information on access and coverage for your prescribed ViiV Healthcare medicine.
1‐844‐588‐3288 (toll free)
Multilingual options available.
Monday–Friday,
8 AM–8 PM (ET)
