Gilead Advancing Access® Co-pay Coupon Card Upload

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.

Leave site Go back

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 Pharmacy ID Number:

Document Upload

Drag and drop your image here or

Select a document to upload

(JPG, GIF, PNG, PDF or TIFF)

Selected

This file extension is not allowed Please upload a file with size < 5MB Please upload the mentioned file extension with size < 5MB each and < 25 MB total

Please upload a required document

By checking this box, I certify that I have the patient's permission to upload their EOB documentation to the co-pay coupon program vendor.

Required field

Your claim has been successfully submitted

Thank you for submitting your claim. We'll review the document you provided and follow up if necessary. If you have any questions, please contact us at 1-800-226-2056, available Monday through Friday, 9 AM to 8 PM ET.

We’re sorry

The site you requested is currently unavailable.

Please call 1-800-226-2056 to speak to a customer service representative.

This website is intended for US healthcare professionals

Go to healthcare professionals site Go to patient site

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.

Page Title

Submit your co-pay claim

Document Upload

Your claim has been successfully submitted

We’re sorry