Whether you need a co-pay card or already have one, you can start saving with the VEMLIDY Co-pay Coupon Program by using the form below to confirm your eligibility.
In order to receive the benefits of the program, it is important that you provide accurate information. When filling your prescription, be sure to have your card available.
Translation services are available in a variety of languages—please call 1-877-627-0415 to request assistance.
PLEASE ANSWER ALL OF THE QUESTIONS BELOW:
We are sorry, the form requires some corrections.
Please complete the items highlighted in red.
VEMLIDY Co-pay Coupon Program Terms and Conditions
The VEMLIDY Co-pay Coupon Program will cover the out-of-pocket costs of your VEMLIDY prescriptions up to a maximum of $3,600 per year. This maximum applies to all eligible Gilead medications for the program.
The VEMLIDY Co-Pay Coupon Card (“Card”) can be used only by eligible residents of the U.S., Puerto Rico, or U.S. territories at participating eligible retail, specialty, or mail-order pharmacies in the U.S., Puerto Rico, or U.S. territories. Product must originate in the U.S. or Puerto Rico, or U.S. territories. You must be 18 years or older to use the Card for yourself or a minor.
The Card is limited to one per person and is not transferable. No substitutions are permitted. This Card is available for each valid prescription. No other purchase necessary. The offer cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer. Patient may not be currently receiving free drug assistance through Gilead Sciences, Inc. (“Gilead”)’s patient assistance programs.
The Card is not insurance and is not intended to substitute for insurance.
THE CARD IS VALID ONLY FOR PATIENTS WITH COMMERCIAL INSURANCE AND IS NOT VALID FOR PRESCRIPTIONS THAT ARE ELIGIBLE TO BE REIMBURSED:
- IN WHOLE OR PART, BY MEDICARE, MEDICAID OR A MEDICARE PART D PLAN, TRICARE, VA, DoD, PUERTO RICO GOVERNMENT HEALTH INSURANCE PLAN, OR ANY OTHER FEDERAL OR STATE-FUNDED HEALTHCARE BENEFIT PROGRAM (COLLECTIVELY, “GOVERNMENT PROGRAMS”); OR
- BY COMMERCIAL PLANS OR OTHER HEALTH OR PHARMACY BENEFIT PROGRAMS THAT REIMBURSE FOR THE ENTIRE COST OF PRESCRIPTION DRUGS.
Medicare Part D enrollees who are in the prescription drug coverage gap (the “donut hole”) are not eligible for the co-pay coupon. Patients who begin receiving prescription benefits from such Government Programs at any time will no longer be eligible to use the Card. Void where prohibited by law, taxed, or restricted.
Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the offer. Both patient and pharmacist are each individually responsible for reporting receipt of coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Card, as required.
It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Card.
Gilead reserves the right to terminate, rescind, revoke, or modify this Card at any time without notice.