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AccessSivextro Program
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Phone
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844-282-4782
Fax:
844-282-4783
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Eligibility
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This program is for healthcare providers only. Patients must be uninsured. Patients with Medicare Part D are not eligible. The medication must be medically necessary as determined by a doctor. Income requirements have not been disclosed for this program. Patients must be a US resident. |
| Who Can Apply
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Doctors or the doctors office must call to have the application faxed or mailed or they can download the application. |
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Required
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Doctor's must complete, sign the application and attach required documents. Patients must complete their section and sign. |
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Supply
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Not specified |
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Ship To
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Not specified |
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Note
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This program is intended for US HEALTHCARE PROFESSIONALS and/or Professionals involved in Healthcare Reimbursement ONLY.
This program also provides copay assistance for patients with commercial insurance.
Merck Product Replacement Program: 1-866-363-6379 |
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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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| Sivextro tablet |
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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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