RESOURCES FOR PREVYMIS

RESOURCE
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The Merck Access Program
Enrollment Form for The Merck Access Program, including the Merck Patient Assistance Program (Download and print to complete and fax.)
Download
Available Independent Foundation Support
Download
Representative’s Form
Download
Coverage and reimbursement information
Prior Authorization Checklist
Download
Sample Prior Authorization Letter
Download
Appeal Checklist
Download
Sample Appeal Letter
Download
Patient support materials
prevymis.com
Link
Product information
Physician Prescribing Information
Link
Patient Product Information
Link
The information available here is compiled from sources believed to be accurate, but Merck makes no representation that it is accurate. This information is subject to change. Payer coding requirements may vary or change over time, so it is important to regularly check with each payer as to payer-specific requirements.
The information available here is not intended to be definitive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Merck and its agents make no warranties or guarantees, express or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs.