WELCOME TO
THE MERCK
ACCESS PROGRAM
ARE YOU A US HEALTH CARE PROFESSIONAL?
YES
NO
 
 
 
Contact The Merck Access Program
Mon-Fri at 855-257-3932
 
Ask to be contacted by a Reimbursement
Associate by calling 855-257-3932
 
 

 

ENROLL NOW

Please click on the links below to access The Merck Access Program forms that are applicable to you or your patient. Be sure to include all information, including a prescription for KEYTRUDA if you're requesting a referral to the Merck Patient Assistance Program.

Please be sure all signatures are included prior to faxing forms to The Merck Access Program.

DOWNLOAD FORMS

Download, print, and fill out the 2018 enrollment form.

Download, print, and fill out the 2019 enrollment form. Use this form to re-enroll your patients.

Download, print, and fill out the 2018 Spanish enrollment form.

Download, print, and fill out the 2019 Spanish enrollment form. Use this form to re-enroll your patients.


ELECTRONIC FORMS

Complete the 2018 enrollment form online prior to printing and faxing to The Merck Access Program.

Complete the 2019 enrollment form online prior to printing and faxing to The Merck Access Program. Use this form to re-enroll your patients.

Register here for The Merck Access Portal. Once registered, you’ll be able to enroll patients electronically and view various case studies.

 
 

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