The Merck Access Program Electronic Patient Enrollment Form The patient form can be signed and submitted electronically. Please note that your health care provider must also submit the Health Care Provider Enrollment Form.
The Merck Access Program Enrollment Form
Available Independent Foundation Support
Patient support materials
Physician Prescribing Information
Patient Product Information
For more information, contact The Merck Access Program at 855-404-5278 Mon–Fri, 8 AM to 8 PM (ET), to speak to a representative.