Gilead Advancing Access® Co-pay Coupon Card Enrollment

Enrollment

First name:

Last name:

Date of birth (MM/DD/YYYY):

I am an authorized representative signing up on behalf of the patient, who is under 18.

Address 1:

Address 2:

City:

State:

ZIP code:

Email:

Phone number:

Required field

Healthcare provider and facility lookup

Find your healthcare provider by searching with their first and last name.

Healthcare provider first name:

Healthcare provider last name:

ZIP code (Optional):

Find your facility by searching the facility name or ZIP code, or both.

Facility name:

ZIP code:

Fields below will populate based on lookup above. Please check for accuracy

Facility Address 1:

Facility Address 2:

City:

State:

Healthcare provider phone number:

Healthcare provider fax number:

Required field

Your communication preference (OPTIONAL)

If eligible, a digital co-pay coupon card will be available to you directly after you complete this enrollment form. If you would also prefer to have us send you the card, please check below if you’d like us to mail it or email it to you. Mail Email

(Optional)

Marketing communications opt-in (OPTIONAL)

I would like to receive marketing and informational communications from Gilead related to my medical condition, treatment, and/or my prescription medication, including offers, marketing and promotional information, and educational materials, via one or more of the communications methods I agreed to above. I understand that opting in to the marketing and informational communications is not required as a condition of (i) eligibility for health plan benefits or ability to obtain treatment from my healthcare providers, (ii) enrollment in the Program or PAP/MAP, or (iii) purchasing any goods or receiving a co-pay or other support from Gilead. The marketing outreach program is separate from the PAP/MAP. NOTE: Advancing Access may communicate with me as necessary to administer the Program, including PAP/MAP, even if I do not opt in to receive marketing and informational communications from Gilead.

By checking this box, I consent to receive marketing and informational communications from Gilead (as described above) to my phone number provided, including text messages, prerecorded messages and phone calls, which may be sent via autodialer. Text and data rates may apply. I may opt out at any time by texting “STOP.”

Thank you

You are now enrolled for the Gilead Advancing Access® co-pay coupon card.

Open a printable copy of your co-pay coupon card by clicking the “Printable card” button below. You can also save the card to your device. Present your card to your pharmacist to save on your next prescription.

Present your card to your pharmacist to save on your next prescription.

Co-pay Coupon Card

RxBIN:	610020
RxPCN:	ACCESS
RxGRP:	99994028
ISSUER:	(80840)

ID:

Not available for patients who are enrolled in government healthcare prescription drug programs, such as Medicare Part D, Medicaid, VA, DOD, or TriCare. Visit GileadAdvancingAccess.com for terms and conditions. Additional restrictions apply.

BIKTARVY^® (bictegravir/emtricitabine/tenofovir alafenamide)

GENVOYA^® (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide)

ODEFSEY^® (emtricitabine/rilpivirine/tenofovir alafenamide)

DESCOVY^® (emtricitabine/tenofovir alafenamide)

STRIBILD^® (elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate)

COMPLERA^® (emtricitabine/rilpivirine/tenofovir disoproxil fumarate)

TRUVADA^® (emtricitabine/tenofovir disoproxil fumarate)

EMTRIVA^® (emtricitabine)

TYBOST^® (cobicistat)

Patient and Pharmacist:

This is not insurance.

When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription.
Patient is not eligible if prescriptions are paid in part or full by any state or federally funded programs, including, but not limited to, Medicare or Medicaid, Medigap, VA, DOD, or TriCare, and where prohibited by law. Patients enrolled in Medicare Part D are not eligible.
Acceptance of this card and your submission of claims for the Gilead Advancing Access^® Co-pay Coupon Program are subject to the terms and conditions posted at GileadAdvancingAccess.com.
Submit transaction to BIN# on the front of this card.
If primary coverage exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
For questions regarding setup, claim transmission, patient eligibility, or other issues for BIKTARVY^®, GENVOYA^®, ODEFSEY^®, DESCOVY^®, STRIBILD^®, COMPLERA^®, TRUVADA^®, EMTRIVA^®, or TYBOST^® programs, call 1-877-505-6986 (8 AM to 8 PM EST, Monday through Friday).

Gilead Advancing Access^® Co-pay Coupon Terms and Conditions:

The Gilead Advancing Access^® Co-pay Coupon (“Coupon”) provides financial assistance for the out-of-pocket costs for eligible commercially insured patients as described in the Coupon Benefits. Coupon benefits are limited to financial assistance for patient cost-sharing for the applicable Gilead product only. The Coupon will not cover, and shall not be applied toward, the cost of any dosing procedure or any other healthcare provider service or supply charges or other treatment costs.
The Coupon can be used only by eligible residents of the US, Puerto Rico, or US territories at participating eligible pharmacies in the US, Puerto Rico, or US territories. Product must be dispensed in the US, Puerto Rico, or US territories. Individuals must be at least 18 years old to use the Coupon themselves or to enroll in the Coupon on behalf of a minor.
To use the Coupon, the patient (or the patient’s legal representative on behalf of the patient, as applicable) must personally complete the enrollment process for the Coupon. Third-party payers, pharmacy benefit managers, or the agents of either, are prohibited from assisting patients with enrolling in the Coupon. Any decision to enroll in the Coupon must be made voluntarily by the patient.
The Coupon is not insurance and is not intended to substitute for insurance. Uninsured and cash-paying patients are not eligible to use the Coupon. The Coupon is valid only for prescriptions that are reimbursed by commercial insurance and is not valid for prescriptions that are eligible to be reimbursed:
- in whole or in part by Medicare or a Medicare Part D plan, Medicaid, TRICARE, VA, DOD, Puerto Rico Government Health Insurance Plan, or any other state or federally funded healthcare benefit program (collectively, “Government Programs”); or
- by commercial plans or other health or pharmacy benefit programs that reimburse for the entire cost of prescription drugs or prohibit the Coupon’s use.
Patients who begin receiving prescription benefits from Government Programs at any time must notify Gilead of this fact by contacting Advancing Access at 1-800-226-2056 and will no longer be eligible to use the Coupon.
The Coupon is limited to one per person and is not transferable. No substitutions are permitted. This Coupon is offered to, and intended for the sole benefit of, eligible patients and may not be utilized for the benefit of third parties, including, without limitation, third-party payers, pharmacy benefit managers, or the agents of either. If Gilead determines that a patient’s insurer has implemented a program that adjusts patient cost-sharing obligations based on the availability of support under the Coupon program (sometimes called a “co-pay maximizer program”), unless prohibited by law, Gilead may discontinue the cost-sharing assistance available under the Coupon after providing assistance in an amount not to exceed $9,500 or current maximum limit. If Gilead determines that a patient’s insurer has implemented a program that excludes the financial assistance provided under the Coupon program from counting towards the patient’s deductible or out-of-pocket cost limitations (sometimes called an “accumulator adjustment program”), unless prohibited by law, Gilead may reduce the cost-sharing assistance available under the Coupon to a per claim maximum of $25. Patients may contact Advancing Access® at 1-800-226-2056 to determine if additional cost-sharing assistance is available.
The Coupon is only available with a valid prescription. No other purchase is necessary to redeem this offer.
The Coupon cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer (including, without limitation, any program offered by a third-party payer or pharmacy benefit manager, or an agent of either, that adjusts patient cost-sharing obligations). Patients are not eligible to use the Coupon for a product if they are currently receiving free drug assistance through Gilead Sciences, Inc. (“Gilead”)’s patient assistance program for that product.
The Coupon will not reimburse any payments made by Flexible Spending Account (FSA), Health Savings Account (HSA), Health Reimbursement Account (HRA), or any other payor, discount/co-pay program, or other offer.
Void where prohibited by law, taxed, or restricted.
Patient, pharmacist, and prescriber agree not to seek reimbursement for all, or any part of the benefit received by the patient through the Coupon. Both patient and pharmacist are each individually responsible for reporting receipt of the Coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Coupon, as may be required.
It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Coupon.
Certain information pertaining to your use of the Coupon will be shared with Gilead, the sponsor of the Coupon, and its affiliates. The information disclosed will include the patient co-pay ID, pharmacy demographics, prescriber information, and details relating to the coupon claim, such as co-pay amount, insurance details, and the therapy received. For more information, please see the Gilead Privacy Policy at www.gilead.com/privacy.
Gilead Sciences reserves the right to terminate, rescind, revoke, or modify the Coupon for any reason at any time without notice.

The information contained in this document is intended for audiences in the United States only. The content in this document may not apply to non-U.S. audiences as regulatory control, legal requirements, and/or medical practices may vary in other countries.

ADVANCING ACCESS, BIKTARVY, COMPLERA, DESCOVY, EMTRIVA, GENVOYA, ODEFSEY, STRIBILD, TRUVADA, TYBOST, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies.

Co-pay Coupon Card

RxBIN:	610020
RxPCN:	ACCESS
RxGRP:	99994028
ISSUER:	(80840)

ID:

BIKTARVY^® (bictegravir/emtricitabine/tenofovir alafenamide)

GENVOYA^® (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide)

ODEFSEY^® (emtricitabine/rilpivirine/tenofovir alafenamide)

DESCOVY^® (emtricitabine/tenofovir alafenamide)

STRIBILD^® (elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate)

COMPLERA^® (emtricitabine/rilpivirine/tenofovir disoproxil fumarate)

TRUVADA^® (emtricitabine/tenofovir disoproxil fumarate)

EMTRIVA^® (emtricitabine)

TYBOST^® (cobicistat)

Patient and Pharmacist:

This is not insurance.

When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription.
Patient is not eligible if prescriptions are paid in part or full by any state or federally funded programs, including, but not limited to, Medicare or Medicaid, Medigap, VA, DOD, or TriCare, and where prohibited by law. Patients enrolled in Medicare Part D are not eligible.
Acceptance of this card and your submission of claims for the Gilead Advancing Access^® Co-pay Coupon Program are subject to the terms and conditions posted at GileadAdvancingAccess.com.
Submit transaction to BIN# on the front of this card.
If primary coverage exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
For questions regarding setup, claim transmission, patient eligibility, or other issues for BIKTARVY^®, GENVOYA^®, ODEFSEY^®, DESCOVY^®, STRIBILD^®, COMPLERA^®, TRUVADA^®, EMTRIVA^®, or TYBOST^® programs, call 1-877-505-6986 (8 AM to 8 PM EST, Monday through Friday).

Printable card Save card

Welcome to the Gilead Advancing Access® co-pay program

Present your co-pay coupon card to your healthcare provider or pharmacist to save on your prescription.

Co-pay Coupon Card

SUNLENCA^® (lenacapavir) injection 463.5 mg/1.5 mL and tablets 300 mg

Medical

Payor ID: 56155

Group: 00003678

Member ID:

Pharmacy

BIN: 610020

Group: 99994268

Member ID:

Not available for patients who are enrolled in government healthcare prescription drug programs, such as Medicare, Medicaid, VA, DOD, or TriCare. Additional restrictions apply. Visit gileadadvancingaccess.com for terms and conditions.

Below are instructions for processing both a pharmacy and medical claim utilizing the Advancing Access^® Co-pay Coupon program.

Pharmacy Claims

The specialty pharmacy should submit the primary claim to the patient’s insurance plan
After the primary insurance has processed, use the co-pay coupon pharmacy claim processing information above to complete a secondary claim submission
Funds will be available up to the annual maximum amount of $9,600 for the co-pay coupon program

Buy & Bill (HCP Initiated) Claims

Provider submits a primary claim to the patient’s health insurance plan
Upon receipt of the Explanation of Benefits (EOB) from the patient’s insurance plan, there are two methods by which a secondary medical claim may be completed to utilize the co-pay coupon program
1. Electronic Medical Claim Adjudication: The healthcare provider should submit the secondary claim and required documents (EOB) using the patient’s medical claim processing information above. The provider will receive payment through the payment vehicle that is set up in their system. For further instructions, please contact the helpdesk below.
  
  OR
2. Virtual Card: The healthcare provider submits the EOB to the Advancing Access Co-pay Coupon program by going to https://www.gileadadvancingaccess.com/copay-coupon-card and clicking the “Upload” button. The approved funds will be loaded on a virtual card that will be faxed to the number that was provided during the enrollment process.

Co-pay Coupon Terms and Conditions:

The Gilead Advancing Access^® Co-pay Coupon (“Coupon”) provides financial assistance for the out-of-pocket costs for eligible commercially insured patients as described in the Coupon Benefits. Coupon benefits are limited to financial assistance for patient cost-sharing for the applicable Gilead product only. The Coupon will not cover, and shall not be applied toward, the cost of any dosing procedure or any other healthcare provider service or supply charges or other treatment costs.
The Coupon can be used only by eligible residents of the US, Puerto Rico, or US territories at participating eligible pharmacies in the US, Puerto Rico, or US territories. Product must be dispensed in the US, Puerto Rico, or US territories. Individuals must be at least 18 years old to use the Coupon themselves or to enroll in the Coupon on behalf of a minor.
To use the Coupon, the patient (or the patient’s legal representative on behalf of the patient, as applicable) must personally complete the enrollment process for the Coupon. Third-party payers, pharmacy benefit managers, or the agents of either, are prohibited from assisting patients with enrolling in the Coupon. Any decision to enroll in the Coupon must be made voluntarily by the patient.
The Coupon is not insurance and is not intended to substitute for insurance. Uninsured and cash-paying patients are not eligible to use the Coupon. The Coupon is valid only for prescriptions that are reimbursed by commercial insurance and is not valid for prescriptions that are eligible to be reimbursed:
- in whole or in part by Medicare or a Medicare Part D plan, Medicaid, TRICARE, VA, DOD, Puerto Rico Government Health Insurance Plan, or any other state or federally funded healthcare benefit program (collectively, “Government Programs”); or
- by commercial plans or other health or pharmacy benefit programs that reimburse for the entire cost of prescription drugs or prohibit the Coupon’s use.
Patients who begin receiving prescription benefits from Government Programs at any time must notify Gilead of this fact by contacting Advancing Access at 1-800-226-2056 and will no longer be eligible to use the Coupon.
The Coupon is limited to one per person and is not transferable. No substitutions are permitted. This Coupon is offered to, and intended for the sole benefit of, eligible patients and may not be utilized for the benefit of third parties, including, without limitation, third-party payers, pharmacy benefit managers, or the agents of either. If Gilead determines that a patient’s insurer has implemented a program that adjusts patient cost-sharing obligations based on the availability of support under the Coupon program (sometimes called a “co-pay maximizer program”), unless prohibited by law, Gilead may discontinue the cost-sharing assistance available under the Coupon after providing assistance in an amount not to exceed $9,500. If Gilead determines that a patient’s insurer has implemented a program that excludes the financial assistance provided under the Coupon program from counting towards the patient’s deductible or out-of-pocket cost limitations (sometimes called an “accumulator adjustment program”), unless prohibited by law, Gilead may reduce the cost-sharing assistance available under the Coupon to a per claim maximum of $25. Patients may contact Advancing Access^® at 1-800-226-2056 to determine if additional cost-sharing assistance is available.
The Coupon is only available with a valid prescription. No other purchase is necessary to redeem this offer.
The Coupon cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer (including, without limitation, any program offered by a third-party payer or pharmacy benefit manager, or an agent of either, that adjusts patient cost-sharing obligations). Patients are not eligible to use the Coupon for a product if they are currently receiving free drug assistance through Gilead Sciences, Inc. (“Gilead”)’s patient assistance program for that product.
The Coupon will not reimburse any payments made by Flexible Spending Account (FSA), Health Savings Account (HSA), Health Reimbursement Account (HRA), or any other payor, discount/co-pay program, or other offer.
Void where prohibited by law, taxed, or restricted.
Patient, pharmacist, and prescriber agree not to seek reimbursement for all, or any part of the benefit received by the patient through the Coupon. Both patient and pharmacist are each individually responsible for reporting receipt of the Coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Coupon, as may be required.
It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Coupon.
Certain information pertaining to your use of the Coupon will be shared with Gilead, the sponsor of the Coupon, and its affiliates. The information disclosed will include the patient co-pay ID, pharmacy demographics, prescriber information, and details relating to the coupon claim, such as co-pay amount, insurance details, and the therapy received. For more information, please see the Gilead Privacy Policy at www.gilead.com/privacy.
Gilead Sciences reserves the right to terminate, rescind, revoke, or modify the Coupon for any reason at any time without notice.

SUNLENCA, ADVANCING ACCESS, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies.

Co-pay Coupon Card

SUNLENCA^® (lenacapavir) injection 463.5 mg/1.5 mL and tablets 300 mg

Medical

Payor ID: 56155

Group: 00003678

Member ID:

Pharmacy

BIN: 610020

Group: 99994268

Member ID:

You may download a PDF version of the co-pay coupon. Please keep this information on file.

Download card

Below are steps in the processing of both a pharmacy and medical claim utilizing the co-pay coupon program.

Pharmacy Claims

The specialty pharmacy should submit the primary claim to the patient’s insurance plan.
After the primary insurance has processed, use the co-pay coupon pharmacy claim processing information above to complete a secondary claim submission.
Funds will be available up to the annual maximum amount of $9,600 for the co-pay coupon program.

Buy & Bill (HCP-Initiated) Claims

Provider submits a primary claim to the patient’s health insurance plan.
Upon receipt of the Explanation of Benefits (EOB) from the patient’s insurance plan, there are 2 methods by which a secondary medical claim may be completed to utilize the co-pay coupon program.
Electronic Medical Claim Adjudication
The healthcare provider should submit the secondary claim and required documents (EOB) using the patient’s medical claim processing information above. The provider will receive payment through the payment vehicle that is set up in their system.

Virtual Card
The healthcare provider submits the EOB to the Advancing Access Co-pay Coupon Program by going to https://www.gileadadvancingaccess.com/copay-coupon-card and clicking the “Upload” button. The approved funds will be loaded on your behalf via a virtual card that will be sent to your prescriber fax number provided during the enrollment process.

Note for providers: The Co-pay Coupon is for products only, not administration.

If you have any questions, please contact Gilead’s Advancing Access Program at 1-800-226-2056, Monday through Friday from 9 AM to 8 PM ET.

Co-pay program benefits

Subject to the Gilead Advancing Access® Co-pay Coupon (“Coupon”) Terms and Conditions, this program provides the following financial assistance for the out-of-pocket costs for eligible commercially insured patients with a valid prescription:
- Up to $9,600 in cost-sharing assistance per calendar year with no monthly limit for the following product:
  - SUNLENCA® (lenacapavir)
- Up to $7,200 in cost-sharing assistance per calendar year with no monthly limit for the following products:
  - BIKTARVY® (bictegravir/ emtricitabine/ tenofovir alafenamide)
  - DESCOVY® (emtricitabine/ tenofovir alafenamide)
  - GENVOYA® (elvitegravir/ cobicistat/ emtricitabine/ tenofovir alafenamide)
  - TRUVADA® (emtricitabine/ tenofovir disoproxil fumarate)
- Up to $6,000 in patient cost-sharing assistance per calendar year with no monthly limit for the following products:
  - ODEFSEY® (emtricitabine/ rilpivirine/ tenofovir alafenamide)
  - STRIBILD® (elvitegravir/ cobicistat/ emtricitabine/ tenofovir disoproxil fumarate)
  - COMPLERA® (emtricitabine/ rilpivirine/ tenofovir disoproxil fumarate)
- Up to $3,600 in patient cost-sharing assistance per calendar year, with a monthly maximum of $300 in cost-sharing assistance, for the following product:
  - EMTRIVA® (emtricitabine)
- Up to $600 in patient cost-sharing assistance per calendar year, with a monthly maximum of $50 in cost-sharing assistance, for the following product:
  - TYBOST® (cobicistat)
As described in the Coupon Terms and Conditions, Gilead may reduce or discontinue the financial assistance available under the Coupon if it determines the patient is subject to an “accumulator adjustment” or “co-pay maximizer” program.
- If Gilead determines that a patient’s insurer (or its agent) has implemented a program that adjusts patient cost-sharing obligations based on the availability of support under the Coupon program (sometimes called a “co-pay maximizer program”), unless prohibited by law, Gilead may discontinue the cost-sharing assistance available under the Coupon after providing assistance in an amount not to exceed $9,500 or current maximum limit.
- If Gilead determines that a patient’s insurer (or its agent) has implemented a program that excludes the financial assistance provided under the Coupon program from counting towards the patient’s deductible or out-of-pocket cost limitations (sometimes called an “accumulator adjustment program”), unless prohibited by law, Gilead may reduce the cost-sharing assistance available under the Coupon to a per claim maximum of $25. Please contact Advancing Access® at 1-800-226-2056 to determine if additional cost-sharing assistance is available.
These Coupon benefits are subject to change for any reason at any time without notice.

Gilead Advancing Access® co-pay program terms and conditions

The Gilead Advancing Access® Co-pay Coupon (“Coupon”) provides financial assistance for the out-of-pocket costs for eligible commercially insured patients as described in the Coupon Benefits above. Coupon benefits are limited to financial assistance for patient cost-sharing for the applicable Gilead product only. The Coupon will not cover, and shall not be applied toward, the cost of any dosing procedure or any other healthcare provider service or supply charges or other treatment costs.
The Coupon can be used only by eligible residents of the US, Puerto Rico, or US territories at participating eligible pharmacies in the US, Puerto Rico, or US territories. Product must be dispensed in the US, Puerto Rico, or US territories. Individuals must be at least 18 years old to use the Coupon themselves or to enroll in the Coupon on behalf of a minor.
To use the Coupon, the patient (or the patient’s legal representative on behalf of the patient, as applicable) must personally complete the enrollment process for the Coupon. Third-party payers, pharmacy benefit managers, or the agents of either, are prohibited from assisting patients with enrolling in the Coupon. Any decision to enroll in the Coupon must be made voluntarily by the patient.
The Coupon is not insurance and is not intended to substitute for insurance. Uninsured and cash-paying patients are not eligible to use the Coupon. The Coupon is valid only for prescriptions that are reimbursed by commercial insurance and is not valid for prescriptions that are eligible to be reimbursed:
- in whole or in part by Medicare or a Medicare Part D plan, Medicaid, TRICARE, VA, DOD, Puerto Rico Government Health Insurance Plan, or any other state or federally funded healthcare benefit program (collectively, “Government Programs”); or
- by commercial plans or other health or pharmacy benefit programs that reimburse for the entire cost of prescription drugs or prohibit the Coupon’s use.
Patients who begin receiving prescription benefits from Government Programs at any time must notify Gilead of this fact by contacting Advancing Access at 1-800-226-2056 and will no longer be eligible to use the Coupon.
The Coupon is limited to one per person and is not transferable. No substitutions are permitted. This Coupon is offered to, and intended for the sole benefit of, eligible patients and may not be utilized for the benefit of third parties, including, without limitation, third-party payers, pharmacy benefit managers, or the agents of either. If Gilead determines that a patient’s insurer has implemented a program that adjusts patient cost-sharing obligations based on the availability of support under the Coupon program (sometimes called a “co-pay maximizer program”), unless prohibited by law, Gilead may discontinue the cost-sharing assistance available under the Coupon after providing assistance in an amount not to exceed $9,500 or current maximum limit. If Gilead determines that a patient’s insurer has implemented a program that excludes the financial assistance provided under the Coupon program from counting towards the patient’s deductible or out-of-pocket cost limitations (sometimes called an “accumulator adjustment program”), unless prohibited by law, Gilead may reduce the cost-sharing assistance available under the Coupon to a per claim maximum of $25. Patients may contact Advancing Access® at 1-800-226-2056 to determine if additional cost-sharing assistance is available.
The Coupon is only available with a valid prescription. No other purchase is necessary to redeem this offer.
The Coupon cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer (including, without limitation, any program offered by a third-party payer or pharmacy benefit manager, or an agent of either, that adjusts patient cost-sharing obligations). Patients are not eligible to use the Coupon for a product if they are currently receiving free drug assistance through Gilead Sciences, Inc. (“Gilead”)’s patient assistance program for that product.
The Coupon will not reimburse any payments made by Flexible Spending Account (FSA), Health Savings Account (HSA), Health Reimbursement Account (HRA), or any other payor, discount/co-pay program, or other offer.
Void where prohibited by law, taxed, or restricted.
Patient, pharmacist, and prescriber agree not to seek reimbursement for all, or any part of the benefit received by the patient through the Coupon. Both patient and pharmacist are each individually responsible for reporting receipt of the Coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Coupon, as may be required.
It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Coupon.
Certain information pertaining to your use of the Coupon will be shared with Gilead, the sponsor of the Coupon, and its affiliates. The information disclosed will include the patient co-pay ID, pharmacy demographics, prescriber information, and details relating to the coupon claim, such as co-pay amount, insurance details, and the therapy received. For more information, please see the Gilead Privacy Policy at www.gilead.com/privacy.
Gilead Sciences reserves the right to terminate, rescind, revoke, or modify the Coupon for any reason at any time without notice.

Need help? Call 1-800-226-2056 to speak with a program specialist. We are available Monday through Friday, 9 AM to 8 PM ET. Please let us know if English is not your preferred language.

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Enrollment

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Co-pay Coupon Card

Patient and Pharmacist:

Co-pay Coupon Card

Patient and Pharmacist:

Welcome to the Gilead Advancing Access® co-pay program

Co-pay Coupon Card

Co-pay Coupon Card

Pharmacy Claims

Buy & Bill (HCP-Initiated) Claims

We’re sorry