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Patient Assistance Information

 
1 Program for Complera tablet
 
 
Gilead Advancing Access

P.O Box 13185
La Jolla, CA 92039-3185
Phone : 800-226-2056
Fax: 800-216-6857
Eligibility
> This program is intended for patients that are uninsured. Medicare Part D patients are not eligible for this program. Income based on FPL. Must be a US resident
Who Can Apply
> Call for application to be faxed or mailed. Return application via fax or mail. Patient and Doctor notified in writing of decision in 3-5 business days.
Required
> Medically appropriate condition/diagnosis required. Doctor must complete and sign application. Patient must complete application, sign, and attach proof of income.
Supply
> Amount/Supply varies. *see below for details. Patient contacts pharmacy for refills. Refill limit not specified. Re-application process not specified.
Ship To
> Varies. *see below for details. Ships within 2 business days.
Note
> Insurance benefits, claims assistance and/or other reimbursement help is offered. If the application is for Vistide, then prescription must be included because it will be sent to the doctor's office. The other medications are given using a pharmacy card. This program is for outpatient use only. 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.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Complera tablet
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Advancing Access Program
(Requires Acrobat Reader