Submit Your Co-pay Claim

Please select a file saved on your device in one of the formats listed below to upload and submit a co-pay claim for SUNLENCA® (lenacapavir).

Patient Co-pay Card ID Number:

*Required field

A card ID must be entered to proceed A card ID must be a 9-digit or an 11-digit number Your 9-digit card number is no longer valid. Please complete the enrollment process here to get a new 11-digit card number. The information you entered is not valid. Please try again. If you still have trouble, please call for assistance

A medical ID must be a 9-digit or an 11-digit number

Document Upload

Please upload a required document

*Required field

In order to submit your claim, you must certify permission on behalf of the patient. If you would like to discuss further, please call for assistance