Contact info
- Phone
- 1-844-588-3288
- Fax
- 1-844-208-7676
- Mailing address
- PO Box 5490Louisville, KY 40255
Eligibility
- Contact program for eligibility criteria.
- Income limit, single
- 500% of the federal poverty level
- Income limit, couple
- 500% of the federal poverty level
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- No
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Proof of income
- Prescription
- Prescriber license number
- NPI number
- State license number
- Who can sign
- Not published
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Patient must contact the program to arrange for refills.
- Staying enrolled
- New application every 12 months
- New proof of income every 12 months
More from the program
- Non Medicare Part D patients who need medicine that same day should ask their physician to enroll them in the program by phone.
- Patients enrolled in a Medicare Part D prescription drug plan must first apply via mail or fax and be found eligible before medicine can be shipped.
Medications covered
- Dovato (dolutegravir and lamivudine)
- Epivir (lamivudine)
- Juluca (dolutegravir and rilpivirine)
- Retrovir (zidovudine)
- Rukobia (fostemsavir)
- Selzentry (maraviroc)
- Tivicay PD (dolutegravir)
- Tivicay tablet (dolutegravir)
- Triumeq (abacavir/dolutegravir/lamivudine)
- Triumeq PD (abacavir, dolutegravir, and lamivudine)