Are you a current resident of the United States, Puerto Rico, or U.S. Territories?
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?
Are you in the Medicare Part D coverage gap (Donut Hole)?
If you begin receiving prescription benefits from such state, federal, or government-funded program 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?
When you join the Gilead Advancing Access co-pay coupon program, some information will be gathered. Any information provided may be used for internal business purposes by Gilead and its vendors. The information will help us to better understand patient needs. The following will be collected: the date you filled your prescription, the number of pills the pharmacist gave you, how much the program will refund to you, and other prescription information that is learned during this enrollment.
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© 2017 Gilead Sciences, Inc. All rights reserved. ADMC0252 02/17