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Merck Vaccine Patient Assistance Program
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Phone
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800-293-3881
Fax:
800-528-2551
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Eligibility
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The patient must have no insurance and have an income at or below 200% of the Federal Poverty Level. The patient must be aged 19 or older. The patient must also be residing the US. Patients who do not meet these criteria may still qualify for this program if the patient has special circumstance of financial and medical hardship (but the upper income limit is $41,600 for individuals, $56,000 for couples, $84,800 for a family of four.) For vaccines that are multidoses, the process must be repeated for each dose. |
| Who Can Apply
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section and sign the application. |
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Supply
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Ship To
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Note
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| M-M-R II Injection (measles, mumps and rubella virus vaccine live) |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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