WELCOME TO
THE MERCK
ACCESS PROGRAM
ARE YOU A US HEALTH CARE PROFESSIONAL?
YES
NO

 

ENROLL NOW

Please click on the links below to access The Merck Access Program forms that are applicable to you. If you’re requesting a referral to The Merck Patient Assistance Program, be sure to include all information, including a prescription from your physician for KEYTRUDA.

Please be sure all signatures are included before faxing forms to The Merck Access Program.

DOWNLOAD FORMS

Work with your physician to download, print, and fill out the enrollment form.

Work with your physician to download, print, and fill out the Spanish enrollment form.

Download and use this form as a guide for completing the enrollment form.


ELECTRONIC FORM

Work with your physician to complete the enrollment form online before printing and faxing to The Merck Access Program.

 
 

Contact The Merck Access Program Mon–Fri at 855-257-3932.