Merck Patient Assistance Program: Dificid Tablets

Funded

About

The Merck Patient Assistance Program: Dificid Tablets offers eligible patients access to Dificid free of charge. With the Merck Patient Assistance Program, patients who meet certain eligibility criteria can obtain this essential medication at no cost, ensuring that financial and medical hardships do not impede access to necessary treatments.

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

Enrollment Forms

Enrollment Form