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?
 
 
 
Contact The Merck Access Program
Mon-Fri at 855-257-3932
 
Ask to be contacted by a Field Reimbursement Manager
by calling 855-257-3932
 
 

 

 

ENROLL NOW

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

Please click on the links below to access The Merck Access Program forms that are applicable to you. If your patient is requesting a referral to the Merck Patient Assistance Program, be sure to include all information, including a prescription for KEYTRUDA. Please be sure all signatures are included prior to submitting forms to The Merck Access Program.



Download and Print the Enrollment Form

Download & Print

These forms can be downloaded and printed and require an original signature.

Download the Spanish Enrollment Form
Electronically Sign and Submit the 2020 Enrollment Form

sign & submit electronically

These forms can be signed and submitted electronically.

Patient in Office

Patient Not in Office

The patient must also submit the Electronic Patient Enrollment Form.

Register for the Merck Access Portal

Access the portal

Register here for the Merck Access Portal.

Access the Online Portal

Enrollment Assistance

Access the Sample Enrollment Form

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

 
 

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