Contents may not be reproduced in any form except for personal use and may not be used on any other website without permissionNeedyMeds, a registered 501(c)(3) national nonprofit (#46-3091990), makes every effort to ensure the accuracy of the information on the website. Merck is not associated with any individuals or organizations that may charge patients a fee to assist them in completing applications for our program. 0000224024 00000 n
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Products distributed through the Merck Patient Assistance Programs are free of charge to all eligible patients. 0000006548 00000 n
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Merck Patient Assistance Program Enrollment Form Instructions (Spanish) 09/10/20 Merck Product Replacement Patient Assistance Program Enrollment: Contact program Merck Vaccine Patient Assistance Program Application 09/09/20 Updated June 02, 2020 The office must provide the date of administration and lot number to the Merck Vaccine Patient Assistance Program for all approved doses of vaccine in order for replacement product to be provided. 0000043802 00000 n
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However, we can't guarantee the accuracy or completeness of the information. Merck reserves the right to change or discontinue a program at any time. The Merck Patient Assistance Program provides certain medicines and adult vaccines free of charge to eligible individuals who do not have insurance or whose insurance does not cover their prescription Merck products. trailer
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A new application will need to be completed and submitted to the Merck Vaccine Patient Assistance Program for eligibility assessment prior to a patient receiving a subsequent dose in a multidose series or for another Merck vaccine. 0000008624 00000 n
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Always check with the individual program if you have questions. • You enclosed the Merck Patient Assistance Program enrollment form within the envelope • Prescriptions may not exceed a 90-day supply at a time (maximum of 3 refills) • Patient’s prescription will be sent to the patient’s home address unless otherwise requested by the patient in Section 1 of the application. 0000053788 00000 n
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Individuals who don't meet the insurance criteria may still qualify for the Merck Patient Assistance Program if they attest that they have special circumstances of financial hardship, and their income meets the program criteria. A new application will need to be completed and submitted to the Merck Vaccine Patient Assistance Program for eligibility assessment prior to a patient receiving a subsequent dose in a multi-dose series or for another Merck vaccine. 0000008732 00000 n
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The Merck Patient Assistance Program Helps Those in Need At Merck, we believe that no one should go without the medicines or vaccines they need. 27 0 obj <>
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The Zostavax vaccine is only available for patients age 50 and older.
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Merck National Service Center Report an …
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patient within 30 days following when it was granted, then the patient must submit a new application. 0000044922 00000 n
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