Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 
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Merck Vaccine Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Merck & Co., Inc.


TEL: 800-293-3881


FAX: 800-528-2551
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Patient Assistance Applications

Merck Vaccine Patient Assistance Program Application

 

Brand Name Medications Covered

 
  • Gardasil 9
  • Vaqta vial
  • M-M-R II injection
  • Varivax injection
  • Pneumovax 23 injection
  • Zostavax
  • Recombivax HB injection
 

Generic Name

 
  • hepatitis A vaccine inactivated vial
  • pneumococcal polyvalent vaccine injection
  • hepatitis B vaccine (recombinant) injection
  • varicella virus vaccine live injection
  • human papillomavirus quadrivalent vaccine recombinant
  • zoster vaccine live
  • measles mumps rubella virus vaccine live injection
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Yes
Income At or below 400% of FPL
Diagnosis/Medical Criteria Must be 19 yr old or older
US Residency Required? Yes
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax from Doctor's office prior to administration of vaccine
Doctor's Action Complete section and sign
Applicant's Action Complete section and sign
Decision Communicated Doctor notified
Decision Timeframe Same Day
   

Medication

Amount/Supply Not specified
Sent To Doctor's office
Delivery Time Not specified
Refill Process New application
Limit Not specified
Re-application Varies
   

Additional Information

Decision Timeframe: Made within 10 minutes, if information is complete.

For vaccines that are multidoses, the process must be repeated for each dose.

The Gardasil vaccine is only available for patients age 19-26.
The Zostavax vaccine is only available for patients age 50 and older.

Individuals who don't 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.


Updated July 20, 2018