NeedyMeds

This program provides brand name medications at no or low cost.

Merck Patient Assistance Program

Provided by:

Merck & Company, Inc.

PO Box 690 Horsham, PA 19044-9979 TEL: 800-727-5400 ALT PHONE: FAX: N/A	Program Website

	Languages Spoken: English, Spanish

Patient assistance
applications

Medications

Asmanex Twisthaler Inhalation Powder 110mcg, 220mcg (mometasone inhaled)

Eligibility Requirements

APPLICATION

MEDICATION

Insurance Status	Must have no prescription coverage for needed medication
Those with Part D Eligible?	Yes
Income	At or below 400% of FPL
Diagnosis/Medical Criteria	Not specified
US Residency Required?	Yes

Obtaining	Call or download
Receiving	Sent to doctor or patient
Returning	Mail
Doctor's Action	Complete section, sign
Applicant's Action	Complete section, sign
Decision Communicated	Call for decision
Decision Timeframe	Up to 10 business days

Amount/Supply	90 day supply with up to 3 refills, for a total of up to 1 year of medications
Sent To	Doctor's office or patient's home
Delivery Time	Not specified
Refill Process	Patient requests refills via a toll-free number
Limit	Not specified
Re-application	New application yearly

Additional Information:

At Merck we realize that sometimes exceptions need to be made based on the patient's individual circumstances. 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.