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Merck Access Program for Zepatier
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PO Box 29067
Phoenix, AZ 85038
Phone
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866-251-6013
Fax:
800-803-3104
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Eligibility
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This program is intended for patients that have no prescription coverage for the needed medication. Medicare Part D recipients will be considered on an exception basis. Income requirements for this program have not been disclosed. Patients must have a medically appropriate diagnosis or condition. Patients must also reside in the US, be under the direct care of a licensed US physician and receive US health care services. |
| 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 must complete and sign the application. Patients must also complete and sign the application. Once complete, it can be faxed in. |
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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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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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| Zepatier |
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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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