Healthcare Copay



My Healthcare Company is a 100% web-based solution designed to simplify and organize many of the processes required to operate a Behavioral Healthcare Organization. Mental Health, Developmental Disabilities, and Substance Abuse services can be a daunting task full of documentation and state regulations. My Healthcare Company is designed to combine all of those processes into one intuitive. What is a copay? A copay (or copayment) is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. For example, if you hurt your back and go see your doctor, or you need a refill of your child's asthma medicine, the amount you pay for that visit or medicine is your copay.

ELIGIBILITY REQUIREMENTS: Patients who are enrolled in government healthcare prescription medicine programs are not eligible, including, without limitation, Medicare Part D, Medicaid, VA, DOD, ADAP, state pharmaceutical assistance plan, CHAMPUS, or TRICARE®.

Copay

TO THE PHARMACIST: Please submit the amount of copay authorized by the patient's primary insurance as a secondary transaction to McKesson Corporation (McKesson), ViiVConnect Savings Card?s administrator. By redeeming this card, I certify that: (i) I have received this card 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 that serves as sole or primary insurer for the patient, (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.

For technical difficulties activating this card or other technical processing questions, please call the McKesson help desk at 1-866-747-1170, Monday - Friday 8:00 AM - 9:00 PM ET, Saturday 9:30 AM - 6 PM ET, excluding holidays.

TO 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.

TO THE PATIENT: No activation fee. This card is not valid if there are two or more A/B generic drugs available via NDA or ANDA owners (exclude repackagers). Use must be consistent with terms of your health insurer drug benefit plan. You must report your use of this card to your health insurer if required. This card is the property of ViiV Healthcare and must be returned upon request. By redeeming this card, I, the Patient, certify that: (i) I have read and will comply with requirements, (ii) I am not enrolled in a government healthcare prescription medicine program, and agree to promptly notify McKesson at 1-866-747-1170 if I become enrolled in a government-funded pharmaceutical assistance plan or program after activation of this card, and (iii) I have not submitted and will not submit a claim for reimbursement to any government-funded plan or program. 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 (ViiV) and McKesson (on ViiV's behalf) reserve the right to rescind, revoke, or amend this card without notice.

Mail-order: If you use a mail-order pharmacy, please contact your pharmacy provider to ensure that this offer will be accepted.

Health Care Copay Definition

If you don't have prescription coverage, have questions about insurance coverage, or can't afford your medicines, visit ViiVConnect.com or call 1-844-588-3288 for more information about financial support programs.

Please see www.dovato.com for more information and the full Prescribing Information, including Boxed Warning, for DOVATO.

Healthcare

Please see www.juluca.com for more information and the full Prescribing Information, including Patient Information, for JULUCA.

Please see www.tivicay.com for more information and the full Prescribing Information, including Patient Information, for TIVICAY.

Please see www.triumeq.com for more information and the full Prescribing Information, including Boxed Warning and Medication Guide, for TRIUMEQ.

TRICARE is a registered trademark of the Department of Defense (DoD), DHA.

Health Care Co Pays

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.

Blue Cross Blue Shield Copay

Trademarks are owned by or licensed to the ViiV Healthcare group of companies.

United Healthcare Copay Wave

Copay

Va Health Care Copay

©2019 ViiV Healthcare or licensor. DLLCOUP190004 March 2019 Produced in USA.