Program Applications

Tips for using the applications:

  • You will need Adobe Reader to open the applications. Download this free program or the latest version, which is recommended.
  • Click the button in the top right of the application to turn on the Highlight Fields Option which will highlight the fields to be filled out.
  • Use the "tab" key to easily go to the next field.

As of 05/27/2016 there are 630 applications available.

Click on the first letter of the name of the program. Then click on the application for that program. Dates next to each listing reflect the last update. Some applications may need to be opened with a different viewer depending on which browser you are using. Firefox users may get a message saying "This PDF document might not be displayed correctly." Try clicking on the "Open With Different Viewer" option. If you are still unable to interactively complete the application, use a different browser.

Send the completed application to the address on the application and not to NeedyMeds.

If you cannot find an application or are having trouble printing one, contact the program or company.

Contact NeedyMeds if you find any content errors.

For link problems or other technical problems, send an email to webmaster.

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Makena Prescription Form 05/23/16
Marplan Patient Assistance Program Enrollment Form 05/16/16
MatriStem Prior Authorization & Insurance Verification Form: Contact program
Matulane Patient Assistance Program: Contact program
Meda Pharamaceuticals Patient Assistance Program Application 02/05/16
Medac Pharma Patient Assistance Program Application 04/07/16
Merck Access Program Enrollment Form 02/09/16
Merck Access Program Enrollment Form for Keytruda 04/28/16
Merck Access Program for Zepatier Enrollment Form 02/26/16
Merck Access Program Product Replacement Request Form for Keytruda 04/28/16
Merck Connect Registration Form: Contact program
Merck Patient Assistance Program Enrollment Form 02/05/16
Merck Patient Assistance Program Enrollment Form (Spanish) 02/05/16
Merck Patient Assistance Program Enrollment Form Instruction Letter (Spanish) 02/05/16
Merck Product Replacement Patient Assistance Program: Contact Program
Merck Vaccine Patient Assistance Program Application 02/05/16
Merck Vaccine Patient Assistance Program Application (Spanish) 02/05/16
Midatech Pharma Patient Assistance Program: Contact program
Millennium Reimbursement Assistance for Velcade Enrollment Form 04/19/16
Mission Pharmaceutical Patient Assistance Program: Contact program
Mission Product Request: Contact program
MS Lifelines Enrollment Form: Contact program
MS One to One Patient Assistance Program (Lemtrada): Contact program
MS One to One Start Form (Aubagio) 05/18/16
MS One to One Start Form (Lemtrada): Contact program
MuGard Prescription Form 05/18/16
My IG Source Program Enrollment Form: Contact program
MyAlprolix Consent and Authorization Form 03/09/16
MyAlprolix Consent and Authorization Form (Spanish) 03/09/16
MyAlprolix Free Trial Plus Program Enrollment Form 03/09/16
MyAlprolix Free Trial Plus Program Enrollment Form (Spanish) 03/09/16
MyAlprolix Program Enrollment Form 03/09/16
MyAlprolix Program Enrollment Form (Spanish) 03/09/16
MyEloctate Free Trial Plus Program Enrollment Form 03/10/16
MyEloctate Program Enrollment Form 03/10/16
Mylan Clozapine Patient Assistance Program Application 03/11/16
Mylan EMSAM Transdermal System Patient Assistance Program Application 03/11/16
Mylan EpiPen 2-Pak Auto-Injector Patient Assistance Program Application 03/11/16
Mylan Miacalcin Injection Patient Assistance Program (MMPAP) Application 02/12/16
Mylan Miacalcin Injection Patient Assistance Program (MMPAP) Fax Cover Sheet 02/12/16
Myobloc PAP Enrollment Form 05/02/16
Myobloc Reimbursement Enrollment Form 05/02/16
MyPraluent Enrollment Form 04/14/16

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