PATIENT SUPPORT RESOURCES FOR PREVYMIS
RESOURCE
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Electronic enrollment
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.
Enrollment
The Merck Access Program Enrollment Form
Available Independent Foundation Support
Representative’s Form
Patient support materials
prevymis.com
Product information
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.
This site is intended only for residents of the United States.
Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. US-CYT-01049 09/21
