WELCOME TO
THE MERCK
ACCESS PROGRAM
ARE YOU A US HEALTH CARE PROFESSIONAL?
YES
NO

 

ENROLL NOW

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.



Download & Print

These forms can be downloaded and printed, and require an original signature. Work with your health care provider to complete the enrollment form.

Use this form to re-enroll inThe Merck Access Program.

NEW sign & submit electronically

This patient form can be signed and submitted electronically. Please note that your health care provider must also submit the Health Care Provider Enrollment Form.

Enrollment Assistance

Download and use this form as a guide
for completing the enrollment form.

 
 

Contact The Merck Access Program Mon–Fri at 855-257-3932.