Dosage & Administration Drug label Prior authorization Financial assistance

Tivicay

(dolutegravir)

dolutegravir 10 MG Oral Tablet [Tivicay]dolutegravir 25 MG Oral Tablet [Tivicay]

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NO BLACK BOX WARNING

Dosage & administration

* Pregnancy Testing: Pregnancy testing is recommended before initiation of TIVICAY or TIVICAY PD in adolescents and adults of childbearing potential.
* May be taken without regard to food.

a Rilpivirine dose is 25 mg once daily for those switching to dolutegravir plus rilpivirine. b Alternative combinations that do not include metabolic inducers should be considered where possible.
Adult Population	Recommended Dose
Treatment-naïve or treatment-experienced INSTI-naïve or virologically suppressed (HIV-1 RNA <50 copies per mL) adults switching to dolutegravir plus rilpivirinea	50 mg once daily
Treatment-naïve or treatment-experienced INSTI-naïve when coadministered with certain UGT1A or CYP3A inducers	50 mg twice daily
INSTI-experienced with certain INSTI-associated resistance substitutions or clinically suspected INSTI resistanceb	50 mg twice daily

Pediatric Patients: Treatment-naïve or treatment-experienced INSTI-naïve patients aged at least 4 weeks and weighing at least 3 kg. See Tables 2, 3, and 4 for complete pediatric dosing recommendations. . TIVICAY and TIVICAY PD are not bioequivalent and are not interchangeable on a milligram-per-milligram basis.

a If certain UGT1A or CYP3A inducers are coadministered, then adjust the weight-based dose of TIVICAY to twice daily.
Pediatric Population Body Weight	Recommended Dosea TIVICAY PD Tablets for Oral Suspension
3 kg to less than 6 kg	5 mg once daily
6 kg to less than 10 kg	15 mg once daily
10 kg to less than 14 kg	20 mg once daily
14 kg to less than 20 kg	25 mg once daily
20 kg and greater	30 mg once daily

Alternative dosing recommendations for TIVICAY tablets for patients weighing at least 14 kg :

* 14 kg to less than 20 kg: 40 mg once daily.
* 20 kg and greater: 50 mg once daily.

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Tivicay prescribing information

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prior authorization

Tivicay Prior authorization resources

Complete Letter of Medical Necessity

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Benefits investigation

ViiVConnect Enrollment Form

ViiVConnect Enrollment Form - Spanish

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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financial assistance

Tivicay Financial assistance options

Co-pay savings program

commercial only

Enroll in Patient Savings Program

Activate Co-Pay Card

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Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Bridge program

commercial only

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Overview

Provide patient immediate access to therapy during an insurance delay (typically new starts; some may cover change in insurance)
Limited time/ fill (typically 7-30 days; some may offer additional fill for continued delay up to certain limit)

Patient benefit

100% free (outside of insurance)

Patient eligibility

HCP must enroll patient
May be limited to commercially insured patients (i.e., no government beneficiaries); some programs may allow government beneficiaries

How to sign up

Typically HCP assisted enrollment (via form)

Foundation programs

under insured

no insurance

goverment insurance

65+

ViiVConnect Enrollment Form

ViiVConnect Enrollment Form - Spanish

Viiv Healthcare Patient Assistance Program

Common Patient Assistance Program Application (CPAPA) Companion Document

Common Patient Assistance Program Application (CPAPA)

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Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and co-pays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement

patient education

Tivicay Patient education

Getting started on Tivicay

Instructions For Use [Tablets For Oral Suspension]: HIV

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Patient toolkit

About Tivicay

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Please note:

Access to a Field Reimbursement Manager (FRM) or Medical Science Liaison (MSL) varies by brand and may require talking with your rep first.
Samples are provided at the discretion of the brand.
We are unable to collect Protected Health Information (PHI), fill out forms, or submit them on your behalf.

Tivicay

Dosage & administration

drug label

Tivicay prescribing information

Have more Tivicay questions?

Need to report a Tivicay issue?

prior authorization

Tivicay Prior authorization resources

Benefits investigation

Reimbursement help (FRM)

financial assistance

Tivicay Financial assistance options

Co-pay savings program

Bridge program

Foundation programs

patient education

Tivicay Patient education

Getting started on Tivicay

Patient toolkit

people also ask

Tivicay FAQs

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