Merck Patient Assistance Program

Requirements for uninsured applicants

• Applicants must be at or below 400% federal poverty level to qualify
  • View federal poverty guidelines
• This company will not accept faxed applications, you must mail applications into the company
  • You do not need to include income with the application, just make sure it is filled in correctly on the application
  • You do not need to send a prescription with the application, there is a place on the application for that information
• Medications are shipped to the applicants home
• Applications are good for 1 year from the date approved by the program

Requirement for Medicare Part D applicants

• Medicare Part D enrollees can apply, there are no requirements as far as out-of-pocket spending or being in the coverage gap
  • Applications for all Part D members will be initially denied and returned to the applicant along with an attestation letter
  • Applicant needs to fill out and sign the attestation letter and mail it back along with the original application to be approved
  • If original application is not mailed back with the attestation letter, the application will be denied and you must start the process over
• Applications for Medicare Part D enrollees are valid until December 31st of the current enrollment year