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

Merck Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Merck Patient Assistance Program, Inc.

PO Box 690
Horsham, PA 19044-9979

TEL: 800-727-5400


Languages Spoken:

English, Spanish

Program Website

 

Patient Assistance Applications

Merck Patient Assistance Program Enrollment Form

Merck Patient Assistance Program Enrollment Form (Spanish)

Merck Patient Assistance Program Brochure

HIV Common Application: Merck Patient Assistance Program
 

Brand Name Medications
 
  • Belsomra tablet
  • Janumet tablet
  • Delstrigo tablet
  • Janumet XR tablet; extended release
  • Dificid oral suspension
  • Januvia tablet
  • Dificid tablet
  • Noxafil oral suspension
  • Emend capsule
  • Noxafil tablet; delayed release
  • Emend injection; iv
  • Pifeltro tablet
  • Emend oral suspension
  • Stromectol tablet
  • Isentress HD tablet; film coated
  • Zepatier tablet
  • Isentress tablet; chewable
  • Zolinza capsule
 

Generic Name Medications
 
  • aprepitant capsule
  • metformin-sitagliptin tablet
  • aprepitant oral suspension
  • metformin-sitagliptin tablet; extended release
  • doravirine tablet
  • posaconazole oral suspension
  • doravirine-lamivudine-tenofovir disoproxil fumarate tablet
  • posaconazole tablet; delayed release
  • elbasvir-grazoprevir tablet
  • raltegravir tablet; chewable
  • fidaxomicin oral suspension
  • raltegravir tablet; film coated
  • fidaxomicin tablet
  • sitagliptin tablet
  • fosaprepitant dimeglumine injection; iv
  • suvorexant tablet
  • ivermectin tablet
  • vorinostat capsule
 

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 Not specified
US Residency Required? Must be residing in the US or a US territory, and under the care of a US physician
   

Application
Obtaining Call or download
Receiving Varies
Returning Mail
Doctor's Action Complete section, sign, attach required documents
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
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Patient requests refills via a toll-free number
Limit Contact the program for details
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.

Call for most recent medications as the list is subject to change.

Updated June 29, 2023