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.
Link
Enrollment
The Merck Access Program Enrollment Form
Download
Available Independent Foundation Support
Download
Representative’s Form
Download
Patient support materials
prevymis.com
Link
Product information
Physician Prescribing Information
Link
Patient Product Information
Link
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.