Triumeq

ViiV Healthcare Patient Assistance Program Patient Guide: How to Get Triumeq at Low or No Cost

About This Program

The ViiV Healthcare Patient Assistance Program helps uninsured and underinsured patients access Triumeq (dolutegravir/abacavir/lamivudine) at no cost or reduced cost. Triumeq is a combination antiretroviral medication used to treat HIV-1 infection. This program is operated by the GSK Patient Access Programs Foundation, an independent nonprofit organization separate from ViiV Healthcare.

Who Qualifies for This Program

You may be eligible for the ViiV Healthcare Patient Assistance Program if you meet ALL of the following criteria:

• You reside in one of the 50 U.S. states, the District of Columbia, or Puerto Rico
• You meet financial income eligibility criteria (see income thresholds below)
• You have a valid prescription for Triumeq from your healthcare provider
• You meet one of these insurance requirements:
  • You are uninsured, OR
  • You have Medicare Part A, B, D, or Medicare Advantage and meet other program requirements
• You are NOT currently enrolled in the AIDS Drug Assistance Program (ADAP)
• You are NOT enrolled in Medicaid, Puerto Rico Government Health Plan (Reform, Mi Salud), or any other federal or state government-funded health plan (except Medicare)

If you are under 18 years old, your parent or legal guardian must sign your application.

Income Eligibility Requirements

Your household income must be at or below 500% of the Federal Poverty Level. The table below shows the maximum annual gross income limits for the 48 states and Washington, DC:

If your income exceeds these limits, you may still qualify by demonstrating that your eligible medical expenses bring you within the income eligibility criteria. Contact the program for details about this option.

Special Medicare Part D Requirements

If you have Medicare Part D prescription drug coverage, you must have spent at least $600 on medications in the current year to be eligible for this program. Patients enrolled in Medicare Part D must apply by mail or fax and be found eligible before medication can be shipped.

How to Apply

Step 1: Get a Prescription

Your healthcare provider must give you a valid prescription for Triumeq. Discuss with your doctor whether Triumeq is the right medication for your HIV treatment.

Step 2: Contact the Program

Call the ViiV Healthcare Patient Assistance Program at 1-844-588-3288 (toll-free). The program is available Monday through Friday, 8 AM to 8 PM (ET). Language options are available.

You can also:

• Email your completed enrollment form to info@viivconnectportal.com
• Fax your completed enrollment form to 1-844-208-7676
• Visit ViiVConnect.com for additional information

Step 3: Complete the Application

You will need to complete the ViiV Healthcare Patient Assistance Program enrollment form. Your healthcare provider must also sign the form. You will need to provide:

• Your personal information (name, date of birth, address, contact information)
• Your prescription for Triumeq
• Proof of your household income (such as recent tax returns, pay stubs, or benefit statements)
• Information about your current insurance coverage (if any)

Step 4: Submit Your Application

Submit your completed, signed enrollment form by:

• Fax to 1-844-208-7676, OR
• Mail to the address provided on the form, OR
• Email to info@viivconnectportal.com

If you need medication urgently, ask your healthcare provider (your "Advocate") to enroll you by phone. Non-Medicare Part D patients may receive medication the same day through phone enrollment.

Step 5: Receive Your Medication

Once approved, your medication will be shipped directly to your home. The program typically provides up to a 90-day supply.

Timeline and What to Expect

After you submit your application, a ViiV Healthcare Access Coordinator may reach out to you within a few days to walk you through the process and answer questions. Processing times vary depending on your insurance status and whether you applied by phone, mail, or fax.

Patients with Medicare Part D should expect a longer processing time since applications must be reviewed by mail or fax before medication is shipped.

What If Your Application Is Denied

If you are not approved for the ViiV Healthcare Patient Assistance Program, you may have other options:

• ViiVConnect Patient Savings Program: If you have commercial insurance, you may qualify for a savings card that reduces your copay to as little as $0 for Triumeq
• Alternative Insurance Coverage: An Access Coordinator can help research other insurance options you may qualify for
• Other Assistance Programs: You may be referred to other patient advocacy organizations that can help
• Reapplication: Your circumstances may change, making you eligible in the future

Contact the program at 1-844-588-3288 to discuss your options if your application is denied.

Important Disclaimers

• This program is subject to eligibility requirements, program terms, and conditions, which are subject to change
• These programs do not constitute health insurance
• Enrollment in this program does not guarantee coverage or medication supply
• You must maintain eligibility to continue receiving assistance
• If your income or insurance status changes, you must notify the program

Contact Information

ViiV Healthcare Patient Assistance Program

• Phone: 1-844-588-3288 (toll-free)
• Hours: Monday–Friday, 8 AM–8 PM (ET)
• Fax: 1-844-208-7676
• Email: info@viivconnectportal.com
• Website: ViiVConnect.com

Language options are available. If you have questions about your eligibility or the application process, don't hesitate to call.