At Tibotec Therapeutics, we believe our first responsibility is to the people who rely on our products and we recognize that the cost of medication can make it difficult for some people to get their medicines. As a result, we created the Tibotec Therapeutics Patient Assistance Program and Patient Savings Program.

Patient Assistance Program

Tibotec Therapeutics offers a Patient Assistance Program (PAP) that provides HIV medications at no charge. For more information, call 1-866-836-0114.

• Patient Assistance Program Application Form (Click on the link to view and print the application for the patient assistance program. This form requires Adobe Reader for viewing and printing.)
• Insurance Benefit Verification Form (Click on the link to view and print the Insurance Benefit Verification form. This form requires Adobe Reader for viewing and printing.)

Patient Savings Program

For eligible patients with prescription coverage that may require significant out-of-pocket expenses for their HIV medications, the Patient Savings Program (PSP) is a simple and easy way to reduce out-of-pocket costs for up to 1 year. Patients should refer to the Q&A below for Eligibility Rules and Regulations to determine whether they qualify. For more information, call 1-866-961-7169.

• Patient Savings Program Application Form (Click on the link to view and print the application for the patient assistance program. This form requires Adobe Reader for viewing and printing.)
• Patient Savings Program Q&A (Click on the link to view and print the Patient Savings Program Q&A. This form requires Adobe Reader for viewing and printing.)

ADDITIONAL INFORMATION

The TibotecTherapeuticsLine, 1-866-836-0114, is a convenient, toll-free hotline to answer questions from patients and healthcare providers. It is available Monday through Friday from 9 a.m. to 8 p.m., Eastern Standard Time. TibotecTherapeuticsLine provides reimbursement information including: benefit verification; prior authorization requirements; appeal process and procedures; alternate sources of payment; and additional information about patient assistance. You may also reach us by fax at 1-866-836-0567.

When calling about a patient-specific reimbursement issue, please have the following information available:

• Patient's full name, date of birth, address, telephone, and social security number
• Name and telephone number of insurance plan(s), policy number(s), and name of subscriber
• Physician's name, address, and telephone number
• Patient's financial information if calling on behalf of an uninsured patient, including total gross income, household size, and value of assets

This information is provided for informational purposes only and represents no statement, promise, or guarantee by Tibotec Therapeutics concerning levels of reimbursement, payment, or charge. We strongly suggest that you consult your payer organization about local reimbursement policies.