Patient Enrollment for CABENUVA
To start appropriate patients on CABENUVA, healthcare professionals should submit a CABENUVA Enrollment Form to receive a 1-month supply of oral lead-in (cabotegravir 30 mg and rilpivirine 25 mg tablets).*† Upon patient and provider agreement, ViiVConnect will arrange shipment of the oral lead-in to your practice or your patient's address.
*CABENUVA Enrollment Form is not required for your patients to access their prescribed CABENUVA.
†The oral lead-in is not contingent upon sale and/or purchase of the injectable portion of the regimen.
How to submit the CABENUVA Enrollment Form
COMPLETE CABENUVA ENROLLMENT FORM VIA ViiVCONNECT
Complete and submit the CABENUVA Enrollment Form electronically once your practice is registered in the ViiVConnect Portal
SUBMIT CABENUVA ENROLLMENT FORM VIA FAX
Download and print the CABENUVA Enrollment Form. Once complete, the form can be submitted by FAX to 1-844-208-7676
Have questions about patient enrollment?
ANNOTATED CABENUVA ENROLLMENT FORM
Download an annotated guide with detailed instructions on how to fill out the CABENUVA Enrollment Form
TALK TO AN ACCESS COORDINATOR
Our team of Access Coordinators are available Monday – Friday, 8AM – 11PM (ET) to help answer questions regarding access and coverage of prescribed ViiV Healthcare medications. Call toll free at 1-844-588-3288