Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Updated January 28, 2015


ViiV Healthcare Patient Assistance Program

This program provides brand name medications at no or low cost.

Provided by: ViiV Healthcare

PO Box 52037
Phoenix, AZ 85072

TEL: 877-784-4842

FAX: 877-784-4004
Languages Spoken:

English, Others By Translation Service

Program Website


Patient Assistance Applications

ViiV Healthcare Patient Assistance Program Application

HIV Common Application; ViiV Healthcare



  • Ziagen Oral Solution 20mg/mL (abacavir sulfate)
  • Ziagen Tablet 300mg (abacavir sulfate)

Eligibility Requirements   

Insurance Status Must have no prescription coverage or have spent $600 on drugs in current year with Part D
Those with Part D Eligible? Yes
Income At or below 500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must live in US, DC or Puerto Rico


Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient notified in writing
Decision Timeframe Not specified


Amount/Supply Up to 90 day supply
Sent To Patient's home
Delivery Time Not specified
Refill Process Patient must contact company
Limit One year
Re-application Those with Medicare Part D reapply after spending $600 on prescription medication each year, all others reapply on anniversary date of when they enrolled

Additional Information

Non Medicare Part D patients who need medicine that same day should ask their Advocate (ie, anyone involved in the delivery of the patient's healthcare and is not a family member or friend) to enroll them in ViiV Healthcare PAP by phone. Patients enrolled in a Medicare Part D prescription drug plan must first apply via mail or fax and be found eligible before medicine can be shipped.

This Program participates in the CPAPA. This single common application allows uninsured HIV-positive individuals with low incomes to use one application to apply for multiple assistance programs.

IMPORTANT: Send completed CPAPA to the corresponding addresses listed for each company.