(Pneumococcal Vaccine Polyvalent) 

This private and confidential program provides vaccines free of charge to eligible individuals, primarily the uninsured who, without our assistance, could not afford needed Merck medicines. Individuals who don’t meet the insurance criteria may still qualify for this program if they attest that they have special circumstances of financial and medical hardship, and their income meets the program criteria.


Who May Qualify

You may be eligible for the program if all 3 of the following conditions apply:

  1. You reside in the United States and are age 19 or older*


  2. You have no health insurance coverage (some examples of health insurance coverage include private insurance, HMOs, PPOs, college health plans, Medicaid, veterans' assistance, or any other social service agency support)


  3. You have an annual household income less than:

    • $60,240 or less for individuals
    • $81,760 or less for couples
    • $124,800 or less for a family of 4.

Individuals who do not meet the insurance coverage criteria may still qualify for the vaccine program if the patient has special circumstances of financial and medical hardship.

* You do not have to be a US citizen. Residents of the United States, including US Territories, are also eligible.

For income limits in Alaska and Hawaii, please call 1-800-727-5400.

How to Get Started

Patients should speak with their health care professional about which vaccines may be right for them.

To participate in the program, patients and their licensed prescribers (eg, physicians, nurse practitioners, and physician assistants) must:

  1. Complete and sign an enrollment form — available for download on the right (English or Spanish).

  2. Fax completed form from a participating Licensed Prescriber's Office to 800-528-2551.

The enrollment form must be submitted and approved prior to administration of vaccine in order to qualify.

Forms will be processed quickly* — with a goal of less than 10 minutes — and the Licensed Prescriber's Office will be notified by phone so that qualifying patients can receive the Merck vaccine during that visit.

A new application will need to be completed and submitted to the Merck Vaccine Patient Assistance Program for eligibility assessment prior to a patient receiving a subsequent dose in a multidose series or for another Merck vaccine.

* During business hours (8 AM – 8 PM ET, Monday – Friday)

Check Your Eligibility

Please answer these short questions to see if you may qualify. You must answer ALL questions on this page to be considered.
This information is not collected or retained.


Download Enrollment Form (Application)

Please download and complete the Enrollment Form (Application) on this page or you may call 800-293-3881 if you need assistance.


Enrollment Form (Application)


Enrollment Form (Application)

Video on Enrollment Form (Application)

Enrollment Form (Application) Checklist

Fax completed form from a participating Licensed Prescriber's Office to 800-528-2551.