Learn More About Enrollment

THE MERCK ACCESS PROGRAM

The Merck Access Program is designed to provide reimbursement and insurance coverage–related information for your patient throughout their treatment process.
  SIGN & SUBMIT ELECTRONICALLY DOWNLOAD & PRINT

Enrollment Form




Electronic Healthcare Provider Enrollment Form

The patient must also submit the Electronic Patient Enrollment Form.

 

Enrollment Form

SIGN & SUBMIT ELECTRONICALLY

OR

DOWNLOAD & PRINT

Electronic Healthcare Provider Enrollment Form

The patient must also submit the Electronic Patient Enrollment Form.

SIGN & SUBMIT ELECTRONICALLY

Please click here to access The Merck Access Program Enrollment Form for VERQUVO in Spanish

ENROLLMENT SUPPORT

Does your patient have a legal and/or personal representative who is assisting them? If so, it’s important that you have the representative fill out this form.

Use this link to securely upload documents to submit to The Merck Access Program.