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

Merck Vaccine Patient Program Assistance

This program provides brand name medications at no or low cost

Provided by: Merck & Co., Inc.


TEL: 800-293-3881


ALT PHONE: 800-727-5400
FAX: 800-528-2551 		Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Patient Assistance Applications

Merck Vaccine Patient Assistance Program Application

Merck Vaccine Patient Assistance Program Application (Spanish)

Merck Vaccine Patient Program Assistance Brochure
 

Brand Name Medications
 
  • Gardasil 9 injection; intramuscular
  • Vaqta vial
  • M-M-R II injection
  • Varivax injection
  • Pneumovax 23 injection
  • Vaxneuvance injectable suspension; intramuscular
  • Recombivax HB injection
 

Generic Name Medications
 
  • hepatitis A vaccine inactivated vial
  • pheumococcal 15-valent Conjugate vaccine injectable suspension; intramuscular
  • hepatitis B vaccine (recombinant) injection
  • pneumococcal polyvalent vaccine injection
  • human papillomavirus 9-valent vaccine (recombinant) injection; intramuscular
  • varicella virus vaccine live injection
  • measles mumps rubella virus vaccine live injection
 

Eligibility Requirements   
Insurance Status Determined case by case
Those with Part D Eligible? Contact program for details.
Income At or below 400% of FPL
Diagnosis/Medical Criteria Must be 19 yr old or older
US Residency Required? Must reside in the US
   

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, sign, attach required documents
Applicant's Action Complete section and sign
Decision Communicated Doctor notified
Decision Timeframe Usually same day
   

Medication
Amount/Supply Not specified
Sent To Doctor's office
Delivery Time Not specified
Refill Process Contact program for details.
Limit Contact the program for details
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.

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 November 14, 2023