12/14/2023 0 Comments Biktarvy copay card phone numberNote: All new enrollment is now done electronically or over the phone. *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. If you enroll in the Savings Program via Mobile or Express Enrollment. Patient presents voucher/card to pharmacy for each refill health insurance plan, savings may apply toward co-pay, co-insurance, or deductible. If you are having difficulty accessing this website, please call or email. Patient is sent savings card to be used at pharmacy GoodRx works to make its website accessible to all, including those with disabilities. *See Additional Information section belowįDA Approved Diagnosis - See Program Website for DetailsĬall for information or inform doctor that he/she is in need These are not all the possible side effects of PIFELTRO. The most common side effects of PIFELTRO include: nausea, dizziness, headache, tiredness, diarrhea, stomach (abdominal) pain, and abnormal dreams. Patient Access Network Foundation (PAN) Application: Contact program Tell your doctor right away if you start having new symptoms after starting your HIV-1 medicine. Provided by: Patient Access Network FoundationĮnglish, Spanish, Others By Translation Service Patient Access Network Foundation (PAN) This is a copay assistance program 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. Good Days Program Patient Enrollment Application (pages 3-5) (Spanish) Good Days Program Enrollment Information Pages (pages 1 & 2) 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. New SPRYCEL patients may be eligible for a free 30-day trial offer. If you are a commercially insured patient, you may be eligible for a 0 co-pay offer (subject to an annual maximum benefit of 15,000). Medically appropriate condition/diagnosis For eligible patients, a BMS Access Support care coordinator can help activate or obtain your program cards. Biktarvy tablet (bictegravir-emtricitabine-tenofovir alafenamide).HIV Common Application: Gilead Sciences Advancing Access You can also submit the prescription electronically to the patients pharmacy of choice. TEL: 87 FAX: 21: Languages Spoken: English. Gilead Advancing Access Enrollment Form (Spanish)Īdvancing Access Uninsured 24/7 Support: Contact program Once eligibility is established, you can print a pharmacy medication card immediately so your patient can take it, along with their prescription, to the pharmacy of their choice. Biktarvy: View Coupon: Good Days Program This is a copay assistance program: Provided by: Good Days from CDF: Attn: Enrollment 2611 Internet Blvd. Advancing Access Program This program provides brand name medications at no or low cost
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