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Merck Access Program
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PO Box 29067
Phoenix, AZ 85038
Phone
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855-257-3932
Fax:
855-755-0518
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Eligibility
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This program provides brand name medications at no or low cost to patients that are uninsured or underinsured. Medicare Part D recipients are not eligible. Patients must be 500% below the federal poverty level. A diagnosis code must be provided and the patient must be treated by a US doctor. |
| Who Can Apply
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Anyone interested can call or download the application. |
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Required
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Doctors must complete, sign and attach a prescription. Patients must also complete and sign. Application can then be faxed or mailed. |
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Supply
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Up to 30 day supply |
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Ship To
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Doctor's office or patient's home |
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Note
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At Merck we realize that sometimes exceptions need to be made based on the patient's individual circumstances. Individuals who do not meet the insurance criteria may still qualify for the Merck Patient Assistance Program if they attest that they have special circumstances of financial hardship, and their income meets the program criteria. |
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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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| Emend injection |
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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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Merck Connect
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,
Phone
:
800-489-5119
Fax:
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Eligibility
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This program is for healthcare professionals only. Patient eligibility will be determined on a case by case basis. Income requirements for this program have not been disclosed. The medication must be medically necessary as determined by a doctor. The patient must be treated by a US licensed healthcare professional. |
| Who Can Apply
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Patients can enroll online. |
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Required
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Doctors must enroll in the program. Patients must inform their doctor that they are in need. |
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Supply
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Up to a 30 day supply. |
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Ship To
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Not specified |
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Note
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Resources for HEALTHCARE PROFESSIONALS ONLY.
The Physician must register to access tools and materials for patient support, product sample requests, up-to-date professional resources, and other Merck professional sites. |
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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.
|
| Emend injection |
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