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Merck Access Program for Keytruda
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PO Box 29067
Phoenix, AZ
Phone
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855-257-3932
Fax:
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Eligibility
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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
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Anyone interested can call or download an application. |
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Required
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Doctors and patients must complete and sign the application and it can be returned by fax or mail. |
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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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This program also provides copay assistance. |
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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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| Keytruda |
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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 |
| Download printable Form |
(Requires Acrobat Reader) 
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