To the Patient

To the Pharmacist

To the Healthcare Professional

To the Patient:

You are not required to pay a fee to activate this card or to participate in the ViiV Healthcare Patient Savings Card program. This card must be accompanied by a valid, signed prescription. You are NOT eligible to use this card if you are receiving prescription drug benefits through a government-funded plan or program, such as Medicaid, a Medicare Part D Plan, ADAP, a state pharmaceutical assistance plan, TRICARE, or CHAMPUS. You agree to promptly notify ViiV Healthcare if you begin receiving prescription drug benefits through a government-funded program after activation of this card.

Not valid in Massachusetts if AB-rated generic drug is available for the product.

Your acceptance of this offer must be consistent with terms of any drug benefit plan provided to you by your health insurer. You agree to report your use of this card to your health insurer if required.

Only original accepted—not valid if reproduced. One per purchase. May not be used with any other discount or offer. Offer good only in USA, including Puerto Rico. Void where prohibited by law, taxed, or restricted.

ViiV Healthcare and McKesson (on ViiV's behalf) reserve the right to rescind, revoke, or amend this card without notice.

By redeeming this card, I, the Patient, certify that: (i) I have read and will comply with program rules and requirements, (ii) I am not receiving prescription drug benefits under any government-funded plan or program, and (iii) I have not submitted and will not submit a claim for reimbursement to any government-funded plan or program.

Customer Service: For assistance or questions, please call 1-866-747-1170.

Mail-order: If you use a mail-order pharmacy, please contact your pharmacy provider to ensure that this offer will be accepted. This card is the property of ViiV Healthcare and must be returned upon request.

To the Pharmacist:

Please submit the amount of copay authorized by the patient’s primary insurance as a secondary transaction to McKesson Corporation. By redeeming this coupon, I certify that: (i) I have received this coupon from an eligible patient, (ii) I have dispensed the product as indicated, (iii) I have not submitted, and will not submit, a claim for reimbursement to the patient or any government-funded plan or program. (iv) I have not retained or provided to any person or entity any portion of the amount being made available to the patient, and (v) I will otherwise comply with the terms hereof. I further certify that my participation in this program is consistent with all applicable state laws and any obligations, contractual or otherwise, that I have as a pharmacy provider. It is a violation of federal law to buy, sell, or counterfeit this card.

To the Healthcare Professional:

If you are a healthcare professional who resides outside the state of Vermont but regularly practices in Vermont, please do not download, print, or otherwise accept coupons or vouchers for ViiV Healthcare products.


You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.