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COVERAGE & REIMBURSEMENT SUPPORT

The Merck Access Program can help you understand the benefit investigation, prior authorization, and appeal process.

For more information, please select a category below.

 
 
 

The Merck Access Program can contact insurers to obtain coverage and benefits information for KEYTRUDA.

Getting started is simple

For patient-specific coverage questions

  • 1.Download and complete the appropriate sections of the enrollment form, OR use the electronic enrollment form, OR use the online portal.
    — If your patient is eligible and interested in co-pay assistance or the Merck Patient Assistance Program, please have the patient complete the appropriate sections on the form.
  • 2.Print and fax the completed form to 855-755-0518.
  • 3.A program representative will contact your patient and your office.

If a prior authorization is required, or for assistance in understanding if a prior authorization is required, The Merck Access Program may be able to help.

The prior authorization checklist and sample letter at right can help you to understand the documents and information that may be helpful when seeking a prior authorization. As always, you should check for payer-specific requirements.

Download the Prior Authorization Checklist for KEYTRUDA® (pembrolizumab) Download the Sample Prior Authorization Letter for KEYTRUDA® (pembrolizumab)
 

Getting started is simple

For patient-specific authorization questions

  • 1.Download and complete the appropriate sections of the enrollment form, OR use the electronic enrollment form, OR use the online portal.
    — If your patient is eligible and interested in co-pay assistance or the Merck Patient Assistance Program, please have the patient complete the appropriate sections on the form.
  • 2.Print and fax the completed form to 855-755-0518.
  • 3.A program representative will contact your patient and your office.

If you have submitted a claim and the claim has been denied, you can submit an appeal to your patient’s insurer.

The Merck Access Program may be able to help your office understand the information needed for an appeal submission.

The appeal checklist and sample letter below can help you to understand the documents and information that may be helpful when filing an appeal. As always, you should check for payer-specific requirements.

Download the Appeal Checklist for KEYTRUDA® (pembrolizumab) Download the Sample Appeal Letter for KEYTRUDA® (pembrolizumab)

Getting started is simple

For patient-specific coverage questions

  • 1.Download and complete the appropriate sections of the enrollment form, OR use the electronic enrollment form, OR use the online portal.
    — If your patient is eligible and interested in co-pay assistance or the Merck Patient Assistance Program, please have the patient complete the appropriate sections on the form.
  • 2.Print and fax the completed form to 855-755-0518.
  • 3.A program representative will contact your patient and your office.

The information available here is compiled from sources believed to be accurate, but Merck makes no representation that it is accurate. This information is subject to change. Payer coding requirements may vary or change over time, so it is important to regularly check with each payer as to payer-specific requirements.

The information available here is not intended to be definitive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Merck and its agents make no warranties or guarantees, express or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs.

You are solely responsible for determining the appropriate codes and for any action you take in billing. Information about HCPCS codes is based on guidance issued by the Centers for Medicare & Medicaid Services applicable to Medicare Part B and may not apply to other public or private payers. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of a particular code and for information on additional codes. Diagnosis codes should be selected only by a health care professional.

 
 

To request an appointment with a Nurse Educator, please call 855-257-3932.