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    Each application is valid for up to 12 months after 12 months a new application will be required. At merck we realize that sometimes exceptions need to be made based on the patients individual circumstances. This private and confidential program provides product free of charge to eligible individuals, primarily the uninsured who, without our assistance, could not afford needed merck medicines.

    After downloading the application or receiving your packet in the mail, follow these simple steps to submit your enrollment form for your free merck medicines you may print out the form and fill it out by hand using a black ballpoint pen. Please discuss the risks and benefits of all medicines with your health care provider and take only as prescribed by your health care provider. If you believe that you meet the eligibility criteria for the merck patient assistance program and you have received a prescription for a merck product, call toll-free 8 am to 8 pm est to obtain a brochure outlining the program and an enrollment application, or by clicking on the link on the right.

    You may qualify for the program if you have a household income of 48,560 or less for individuals, 65,840 or less for couples, or 100,400 or less for a family of 4. A single application may provide for up to 1 year of product free of charge to eligible individuals and an individual may reapply as many times as needed. Each prescription may not exceed a 90-day supply at a time, with a maximum of 3 refills.

    If you have been prescribed a merck medicine, you may be eligible for the program if all 3 of the following conditions apply you are a us resident and have a prescription for a merck product from a health care provider licensed in the united states. . Do you have (or intend to get) a prescription for this merck product from a health care provider licensed in the united states? Do you have health insurance or other coverage for this prescription product? (examples include private insurance, hmos, ppos, medicaid, medicare, college health plans, state pharmacy assistance programs, veterans assistance, or any other social service agency support) medicines or adult vaccines distributed through the merck patient assistance programs are free of charge to all eligible patients.

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    A single application may provide for up to 1 year of product free of charge to eligible individuals and an individual may reapply as many times as needed. Do you have (or intend to get) a prescription for this merck product from a health care provider licensed in the united states? Do you have health insurance or other coverage for this prescription product? (examples include private insurance, hmos, ppos, medicaid, medicare, college health plans, state pharmacy assistance programs, veterans assistance, or any other social service agency support) medicines or adult vaccines distributed through the merck patient assistance programs are free of charge to all eligible patients. Individuals who dont meet the insurance criteria may still qualify for this program if they attest that they have special circumstances of financial and medical hardship, and their income meets the program criteria. If you do not meet the prescription drug coverage criteria, your income meets the program criteria, and there are special circumstances of financial and medical hardship that apply to your situation, you can request that an exception be made for you. At merck we realize that sometimes exceptions need to be made based on the patients individual circumstances.

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