All other Terms and Conditions for the Merck Co-pay Assistance Program remain in effect and must be satisfied to receive the benefit.
Please click on the links below to access The Merck Access Program forms that are applicable to you. If you are requesting a referral to the Merck Patient Assistance Program, be sure to include all information, including a prescription from your health care provider for KEYTRUDA. Please be sure all signatures are included prior to submitting forms to The Merck Access Program.
These forms can be downloaded and printed, and require an original signature. Work with your health care provider to complete the enrollment form.
This patient form can be signed and submitted electronically. Please note that your health care provider must also submit the Electronic Health Care Provider Enrollment Form.