Merck Patient Assistance Program: Pifeltro

Funded

About

The Merck Patient Assistance Program: Pifeltro offers significant benefits by providing the drug Pifeltro to eligible patients at no cost. Designed to assist U.S. residents who struggle with affording their medication, the Merck Patient Assistance Program: Pifeltro is ideal for those who are uninsured or those with insurance who meet specific income criteria. By facilitating access to Pifeltro, the Merck Patient Assistance Program: Pifeltro ensures patients can manage their health effectively without the 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, Hours: 8 AM – 8 PM ET Days: Monday – Friday

•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 1 of the application

Enrollment Forms

Enrollment Form