APRETUDE IS COVERED BY MOST PRIVATE INSURERS AND MEDICAID*
*For those with coverage under the medical benefit. Covered means any potential for reimbursement from a health plan and may include step edits, prior authorizations, and other restrictions. Consumers may be responsible for varying out-of-pocket costs based on an individual’s plan and its benefit design. Insurance plans vary. Source: Coverage data are provided by Managed Markets Insight & Technology, LLC, as of June 2024.
9 out of 10 patients pay $10 or less for APRETUDE through a specialty pharmacy
Estimates from IQVIA’s Longitudinal Access and Adjudication Data for APRETUDE. Based on analysis of national pharmacy data, for prescriptions filled by a specialty pharmacy between February 2023 and January 2024. The analysis includes only retail claims that were paid and for which licensed data about the transaction was available. Data does not include buy-and-bill medical benefit claims. Additional costs may be incurred for product administration.
Starting Your Patients on a Specialty Drug
As a specialty drug, APRETUDE may require a departure from your typical practice pattern:
APRETUDE is dispensed through a specialty pharmacy rather than a retail pharmacy
Like other HCP-administered drugs, APRETUDE may be covered through either medical or prescription insurance
APRETUDE may be administered in an HCP's office or an Alternative Site of Care (ASOC)
Starting patients on APRETUDE involves:
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Confirming insurance coverage
APRETUDE may be covered under a patient's medical or pharmacy benefit (sometimes both). This coverage may be through Medicare, Medicaid, commercial insurance, or ADAP.
Benefit coverage
The benefit verification process will confirm how the patient's insurance plan covers APRETUDE, as well as whether it requires a prior authorization. You can begin the benefit verification process for your patient on the ViiVConnect.com Provider Portal.
You can also find a helpful PDF that explains how to read the Summary of Benefits Report and a checklist for managing benefit verification independently on ViiVConnect.com.
ADAP=AIDS Drug Assistance Program.
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Assigning an administration site
In-office administration
Administering APRETUDE in your office may allow you to reconnect every 2 months on patients’ sexual history, check on their current health, and monitor their adherence to medication, among other advantages.
ViiVConnect services and support offer a number of helpful downloadable resources for administering APRETUDE, including an APRETUDE Prescription Flow Overview, guides on subjects such as APRETUDE acquisition and ordering, and checklists for specialty pharmacy and Buy and Bill acquisition options. For more downloads and support, visit ViiVConnect.com.
Injection scheduler tool
Select a target initiation date and view your patient’s potential APRETUDE administration schedule with this helpful online tool.
Alternative Sites of Care (ASOCs)
Some HCPs prefer to send patients to an ASOC, which handles the acquisition and administration of APRETUDE, as well as other services.
The ViiV network ASOCs provide defined services for APRETUDE to support patient adherence. These services include:
- Benefit verification
- Coordination of prior authorizations
- Navigation of ViiVConnect and Patient Savings Program
- Clinician-led onboarding call for patients
- Regular communication with your office
- Multiple patient appointment reminders
The ViiV ASOC Locator Tool may also include non-network ASOCs that have indicated that they can administer APRETUDE at their locations. However, their service offerings may be different than those listed for ViiV Network ASOCs.
The ASOC Locator Tool may help you and your patient find an ASOC.
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Acquiring APRETUDE
How the payer covers APRETUDE will determine how it is acquired:
Manage the entire acquisition process with Buy and Bill
If your patient’s insurance covers APRETUDE under the medical benefit, your office can purchase APRETUDE directly from a specialty distributor and store it on site until you administer it.
Up-to-date payer contracts and accurate coding are crucial for proper reimbursement. Be sure to verify payer coding requirements
Acquire medication through a specialty pharmacy
If your patient’s insurance covers APRETUDE under the pharmacy benefit, or an Assignment of Benefits was performed under the medical benefit, then your office can likely acquire APRETUDE from a specialty pharmacy.
The patient typically pays drug-related copays or coinsurance directly to the specialty pharmacy.
Use an Alternative Site of Care (ASOC)
The ASOC both acquires and administers APRETUDE. Locate an ASOC>
The APRETUDE Starter Sample Program
Before providing a Starter Sample to your appropriate patients, remember to:
1. TEST FOR HIV
- Confirm HIV-negative status before starting APRETUDE. See Important Safety Information below for additional testing recommendations
- Also test with each subsequent injection of APRETUDE
2. VERIFY BENEFITS
- Confirm how your patient’s insurance plan covers APRETUDE and any related steps
- ViiVConnect is an optional resource to help with patient coverage, prior authorizations, and specialty pharmacy assistance. Support also includes help with claim denials and appeals
- RealTime Benefit Verification*
allows you to access a patient’s insurance benefit and coverage information within minutes. One-time registration is required
*Results are based on the patient's in-network benefits for their medication and do not guarantee reimbursement. Reimbursement will be contingent on the payer contract.
3. CONFIRM PATIENT COMMITMENT
- Reiterate the importance of adhering to the APRETUDE dosing and testing schedule
- Schedule the next APRETUDE injection post-Starter Sample(s)
- APRETUDE must be administered by a healthcare provider
- Follow testing and dosing recommendations in the APRETUDE US Prescribing Information
Restrictions apply.
How ViiVConnect can help
Services available include:
- Benefit verification and annual reverification
- Prior authorization, claim denials, and appeals support
- Specialty pharmacy support and appointment reminders for patients
Contact ViiVConnect
Call 1-844-588-3288 (toll-free)
PMUS-CBTWCNT240044
