TibotecTherapeuticsLine provides easy access to reimbursement information including:
- Benefit verification
- Prior authorization requirements
- Appeal process and procedures
- Alternate sources of payment
- Information regarding patient assistance
This information is provided for informational purposes only and represents no statement, promise, or guarantee by Tibotec Therapeutics concerning levels of reimbursement, payment, or charge. We strongly suggest that you consult your payer organization with regard to local reimbursement policies.
This easy and convenient toll-free hotline - 1-866-836-0114 - is available Monday through Friday from 9 a.m. to 8 p.m., Eastern Standard Time, to answer questions from patients and healthcare providers. Our fax number is 1-866-836-0567. When calling about a patient-specific reimbursement issue, please have the following information available:
- Selected patient's information
- Name and telephone number of insurance plan(s), policy number(s) and name of subscriber
- Physician's name, address and telephone number
- Patient's financial information if calling on behalf of an uninsured patient
Patient Assistance Program Application Forms
Click on the link below to view and print the application for the patient assistance program. This form requires the Adobe Reader for viewing and printing.
Patient Assistance Program Application Form - English (PDF)
Benefit Verification Forms
Click on the link below to view and to print the application for Insurance Benefit Verification for PREZISTA™. This form requires the Adobe Reader for viewing and printing.
Benefit Verification Form - English (PDF)
