Gilead Advancing Access® Co-pay Coupon Card Activation

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Please enter your 11-digit card ID number, located on the Gilead Advancing Access® co-pay coupon card you received.

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Your personal information is required for security purposes and is used to confirm your identity as a cardholder.

Are you a current resident of the United States, Puerto Rico, or US territories? The Gilead Advancing Access® co-pay coupon card is available only to residents of the United States, US Territories, or the Commonwealth of Puerto Rico. For more information about your eligibility for this or other programs, please call 1-800-226-2056.

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Are your prescriptions paid for in part or in full under any state or federally funded program, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE? The co-pay coupon card is available only to people who currently do not participate in state or federally funded programs. For more information about your eligibility for this or other programs, please call 1-800-226-2056.

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Are you in the Medicare Part D coverage gap? The co-pay coupon card is available only to people who currently do not participate in state or federally funded programs. For more information about your eligibility for this or other programs, please call 1-800-226-2056.

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If you begin receiving prescription benefits from such state, federal, or government-funded programs at any time, you will no longer be eligible to use the Gilead Advancing Access® co-pay coupon card.

Do you acknowledge your agreement with this statement? In order to be eligible for the co-pay coupon card, you must agree with this statement. If you would like to discuss further, please call 1-800-226-2056.

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Do you understand and agree to the limitations listed in the Gilead co-pay terms and conditions regarding accumulator and maximizer programs? In order to be eligible for the co-pay coupon card, you must agree with this statement. If you would like to discuss further, please call 1-800-226-2056.

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I understand that certain information pertaining to my use of the Gilead co-pay coupon may be used for internal business purposes by Gilead and its vendors. My information may be used to obtain my insurance information through a third-party service provider. Gilead’s third parties may use anonymized or deidentified data for their own purposes, including product development. The information disclosed will help Gilead to better understand patient needs. The following will be collected: the date I filled my prescription, the days’ supply dispensed, and the amount of my co-pay that will be paid for by Gilead Sciences, Inc. as well as other prescription information that is learned during this enrollment. This information will be available to Gilead Sciences, Inc. and third parties working on behalf of Gilead Sciences, Inc. and will not be shared with anyone else.

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

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Which of the following medications are you currently taking? BIKTARVY® (bictegravir/ emtricitabine/ tenofovir alafenamide) COMPLERA® (emtricitabine/ rilpivirine/ tenofovir disoproxil fumarate) DESCOVY® (emtricitabine/ tenofovir alafenamide)

What has your doctor prescribed DESCOVY for? To treat HIV-1 To reduce the risk of getting HIV-1

EMTRIVA® (emtricitabine) GENVOYA® (elvitegravir/ cobicistat/ emtricitabine/ tenofovir alafenamide) ODEFSEY® (emtricitabine/ rilpivirine/ tenofovir alafenamide) STRIBILD® (elvitegravir/ cobicistat/ emtricitabine/ tenofovir disoproxil fumarate) TRUVADA® (emtricitabine/ tenofovir disoproxil fumarate)

What has your doctor prescribed TRUVADA for? To treat HIV-1 To reduce the risk of getting HIV-1

TYBOST® (cobicistat)

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Disclaimer: In certain states, the law restricts patient co-pay coupon assistance for TRUVADA.

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.”

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Your Gilead Advancing Access® co-pay coupon card is now activated.

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

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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.

BIKTARVY, COMPLERA, DESCOVY, EMTRIVA, GENVOYA, ODEFSEY, STRIBILD, SUNLENCA, TRUVADA, and TYBOST are trademarks of Gilead Sciences, Inc., or its related companies.

By following this link, you are leaving this Gilead website. Gilead provides these links as a convenience. But these sites are not controlled by Gilead. Gilead is not responsible for their content or your use of them.

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