RxAssist Home
RxAssist Home Home  |  About Us  |  Contact RxAssist          
      Patient Assistance Program Center
 
 

Program Details

GOOD DAYS from CDF
Good Days Program
Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide)
 
CONTACT INFO
Address: Attn: Enrollment
2611 Internet Blvd., Suite 105
Frisco, TX 75034
Phone: 1-877-968-7233 Provider Phone:
Fax: 1-214-570-3621 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Call for most recent medications list as is subject to change based on available funding.
  • Patients must have valid medical insurance coverage. Patients who are applying for copayment assistance must have at least 50% insurance coverage or more to be eligible for copayment assistance, excluding deductibles.
  • Patients must have been prescribed a medication that is part of the Good Days formulary.
  • Patients must meet our annual household income criteria.
    		•
    Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Not Published
    APPLICATION
    Attachments Required: Financial
    Physician License #
    Required:    		 Not Required
    Prescriber Signature
    Allowed:    		 Not Published
    Application may be
    faxed:    		 Yes
    Eligibility determination
    letter sent:    		 Both Provider and Patient
    MEDICATION
    Receives: Not Published
    Shipped To: Not Published
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: Must reapply at the end of the calendar year.
    Refill Policy: Not Published
    Other Information:

    Last Updated: 11/14/2022

    		  

     

     


    Application Forms
    & Instructions
    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)


    Document Form (Spanish)

     

    Print-friendly version
    About Us I Contact I SiteMap I Privacy I Terms of Use
    This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. Neither RxAssist nor RxVantage is offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Neither RxVantage nor RxAssist provide any warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment. Third party logos, trademarks, brand names and images contained on rxassist.org or rxvantage.com are for demonstration purposes only and are owned by their respective rights holders, who are not affiliated with this Site.

    Copyright © 2024, RxVantage, all rights reserved.