Merck Patient Assistance Program: Dificid Oral Suspension

Funded
About
The Merck Patient Assistance Program: Dificid Oral Suspension offers significant benefits by providing eligible patients with Dificid free of charge. This program is a lifeline for those in the United States who meet specific income and prescription coverage criteria. With the Merck Patient Assistance Program, patients can easily access their medication, ensuring they receive necessary treatment without financial burden.
Insurance requirements: Underinsured, Uninsured
Enrollment Forms
Enrollment Form
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: Yes
•Activation Required: No
Program Details
•Eligible patients receive medication free of charge
•Patients can download the application from the website or call 18007275400 to request one
•All sections of the enrollment form must be completed and signed by the patient and physician
•A single application may include prescriptions for up to 3 Merck medications
•Each prescription may not exceed a 90day supply at a time, with a maximum of 3 refills
•Each enrollment form is valid for up to 12 months; after 12 months a new enrollment form will be required. Under certain circumstances, enrollment may be limited to a calendar year
•Completed applications should be mailed to: Merck Patient Assistance Program, PO Box 690, Horsham, PA 190449979
•Medication will be sent to patient’s home address unless otherwise requested by the physician/prescriber in Section 3 of the application