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 Field Reimbursement Manager
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. Be sure to include all information, including a prescription from your physician for KEYTRUDA if you're requesting a referral to the Merck Patient Assistance Program. Please be sure all signatures are included before faxing forms to The Merck Access Program.

DOWNLOAD FORMS

Download, print, and fill out the enrollment form.

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

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


ELECTRONIC FORMS

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

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

 
 

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