All other Terms and Conditions for the Merck Co-Pay Assistance Program remain in effect and must be satisfied to receive the benefit.
US-KEY-02707 11/20
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.