WELCOME TO
THE MERCK
ACCESS PROGRAM
ARE YOU A US HEALTH CARE PROFESSIONAL?
YES
NO
The Merck Access Program: Are You a US Health Care Professional?

 
 

ENROLL NOW

Use the 2022 enrollment forms to enroll for the 2022 calendar year

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 and Print the Enrollment Form for Patients
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.

Download the Spanish Enrollment Form
Electronically Sign and Submit the 2020 Enrollment Form for Patients
sign & submit electronically

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.

Enrollment Assistance
Access the Sample Enrollment Form for Patients

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

 
 

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