The Merck Access Program representatives can refer patients to the Merck Patient Assistance Program for an eligibility determination for free product.
Patients who do not have insurance or whose insurance does not cover PREVYMIS may be eligible for free product from the Merck Patient Assistance Program if they meet certain financial and medical criteria.
For more information on the program’s eligibility requirements, please visit www.merckhelps.com
1. Download and complete the appropriate sections of the enrollment form, OR use the electronic enrollment form.
If your patient is eligible and interested in co-pay assistance or the Merck Patient Assistance Program, please have the patient complete the appropriate sections.
2. Submit electronically, or print and fax the completed form to 866-866-4127.
3. A program representative will contact your patient and your office.