Learn More About Enrollment

THE MERCK ACCESS PROGRAM

THE MERCK ACCESS PROGRAM

The Merck Access Program is designed to provide reimbursement and insurance coverage-related information for your patient throughout their treatment process.
  SIGN & SUBMIT ELECTRONICALLY DOWNLOAD & PRINT

Enrollment Form

Spanish Enrollment Form

 

Electronic Healthcare Provider Enrollment Form

The patient must also submit the Electronic Patient Enrollment Form.

 

Enrollment Form

Helpful Hints

SIGN & SUBMIT ELECTRONICALLY

OR

Download & Print

Spanish Enrollment Form

Helpful Hints

DOWNLOAD & PRINT

Electronic Healthcare Provider Enrollment Form

The patient must also submit the Electronic Patient Enrollment Form.

Helpful Hints

SIGN & SUBMIT ELECTRONICALLY

Enrollment Support

Does your patient have a legal and/or personal representative who is assisting them? If so, it’s important that you have the representative fill out this form.

 

Use this link to securely upload documents to submit to The Merck Access Program.