Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
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Zetia

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Merck Patient Assistance Program

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

Provided by: Merck & Company, Inc.

PO Box 690
Horsham, PA 19044-9979

TEL: 800-727-5400


Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Merck Patient Assistance Program Enrollment Form

Merck Patient Assistance Program Enrollment Form (Spanish)

Merck Patient Assistance Program Enrollment Form Instruction Letter (Spanish)

 

Medications

  • Zetia tablet (ezetimibe)
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Yes
Income At or below 400% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
   

Application

Obtaining Call or download
Receiving Sent to doctor or patient
Returning Mail original application. Do not fax
Doctor's Action Complete section and sign
Applicant's Action Complete section and sign
Decision Communicated Call for decision
Decision Timeframe Up to 10 business days
   

Medication

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. Individuals who do not 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.

*The Enrollment Form must be mailed. Please do not fax.
Updated June 09, 2015


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Zetia

View Coupon View Coupon

Merck Connect

For Healthcare Professionals Only.

Provided by: Merck & Company, Inc.


TEL: 800-489-5119


Languages Spoken:

English

Program Website

 

Program Applications and Forms

 Merck Connect Registration Form: Contact program

 

Medications

  • Zetia tablet (ezetimibe)
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Determined case by case
Income Not disclosed
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Must be treated by US licensed healthcare provider
   

Application

Obtaining Enroll online
Receiving Not specified
Returning Not specified
Doctor's Action Enroll in the program
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 30 day supply
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.

The Physician must register to access tools and materials for patient support, product sample requests, up-to-date professional resources, and other Merck professional sites.

Updated August 13, 2015