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How To Get Started

Merck Patient Assistance Program

If you believe that you meet the guidelines for the Merck Patient Assistance Program and you have received a prescription for a Merck medicine, call toll-free 1-800-727-5400 8 AM to 8 PM EST to obtain a brochure outlining the program and an enrollment application, or by clicking on the link on the right. After downloading the application or receiving your packet in the mail, follow these simple steps to submit your enrollment form for your free Merck medicines:

Complete ALL information on the enrollment form.

  • You may fill in the fields online and print it.


  • You may print out the form and fill it out by hand using a black ballpoint pen.

Take the completed application to your physician/prescriber. Both the physician/prescriber and the patient MUST sign the application.

Have your physician/prescriber write your prescription(s) in Section 2 of the application.

  • A single application may include prescriptions for up to 3 Merck medicines.
  • Each prescription may not exceed a 90-day supply at a time, with a maximum of 3 refills.
  • Each application is valid for up to 12 months; after 12 months a new application will be required. Under certain circumstances, enrollment may be limited to a calendar year.

Mail completed applications to:

  • Merck Patient Assistance Program
  • PO Box 690
  • Horsham, PA 19044-9979

Please Note:

  • Incomplete or incorrectly completed applications will be returned.
  • Section 2 is your prescription. Your physician/prescriber does not need to write your prescription on a separate prescription form.
  • Your medication will be sent to your home address unless otherwise requested by the physician/prescriber in Section 3 of the application.
  • For additional applications or assistance, please call 1-800-727-5400.

Other Important Information

Please discuss the risks and benefits of all medicines with your health care provider and take only as prescribed by your health care provider.