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Patient Assistance Information

 
 
 
Merck Access Program for Zepatier

PO Box 29067
Phoenix, AZ 85038
Phone : 866-251-6013
Fax: 800-803-3104
Eligibility
> 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
> Anyone interested can call or download an application.
Required
> Doctors must complete and sign the application. Patients must also complete and sign the application. Once complete, it can be faxed in.
Supply
> Not specified
Ship To
> Not specified
Note
>
 
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.
 
Zepatier
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader