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. 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 & Print

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

Use this form for patientschoosing to re-enroll.

NEW sign & submit electronically

These forms can be signed and submitted electronically.

Patient in Office

Use this form if the patient is in the office and you are able to complete the form together.

Patient Not in Office

Use this form when the patient is not in the office to complete the form with you.

The patient must also submit the Electronic Patient Enrollment Form.

Access the portal

Register here for the Merck Access Portal.

Enrollment Assistance

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.