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Patient Assistance Information

 
 
 
Merck Access Program for Keytruda

PO Box 29067
Phoenix, AZ
Phone : 855-257-3932
Fax:
Eligibility
> Patients must be uninsured or underinsured. Medicare Part D recipients are not eligible. Patients must be at or below 500% federal poverty level. A diagnosis code must be provided and patients must be treated by a US doctor.
Who Can Apply
> Anyone interested can call or download an application.
Required
> Doctors and patients must complete and sign the application and it can be returned by fax or mail.
Supply
> Up to 30 day supply
Ship To
> Doctor's office or patient's home
Note
> This program also provides copay assistance.
 
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.
 
Keytruda
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
Download printable Form
(Requires Acrobat Reader