For Information About a Specific Product


Before prescribing SYLATRON, please read the accompanying Prescribing Information (5 mL diluent), including the Boxed Warning about depression and other neuropsychiatric disorders. The Medication Guide and Instructions for Use (5 mL diluent) also are available.

The Merck Access Program
How may we assist?

The Merck Access Program can answer questions about

  •  Insurance coverage for patients
  •  Reimbursement
  •  Benefit investigations, prior authorizations, and appeals
  •  Co-pay assistance for eligible patients
  •  Referrals to the Merck Patient Assistance Program

Getting started is simple

For patient-specific coverage questions

  •  
    Download and complete the appropriate sections of the enrollment form (if your patient is eligible and interested in co-pay assistance or the Merck Patient Assistance Program, please have the patient complete the appropriate sections on the form).
  •  
    Fax the completed form to 855-755-0518.
  •  
    A program representative will contact your office.

Program representatives are on the line

A dedicated representative may be able to

  • Research your patient’s insurance benefits
  • Obtain information on your patient’s out-of-pocket costs
  • Provide information on co-pay assistance options
  • Refer patients to the Merck Patient Assistance Program
  • Answer questions about filling out the enrollment form
Coverage and Reimbursement Support

The Merck Access Program can help you understand the benefit investigation, prior authorization, and appeal process.

The Merck Access Program may be able to

  •  
    Contact insurers to obtain coverage and benefits information
  •  
    Help your office understand if a prior authorization is required and the information needed for prior authorization
  •  
    Help your office understand the information needed for an appeal submission if you have submitted a claim to your patient’s insurer and the claim has been denied

Additional Resources

The checklists and sample letters below can help you understand the documents and information that may be helpful when seeking a prior authorization or filing an appeal. As always, you should check for payer-specific requirements.

Getting started is simple

For patient-specific coverage questions

  •  
    Download and complete the appropriate sections of the enrollment form (if your patient is interested in co-pay assistance or the Merck Patient Assistance Program, please have the patient complete the appropriate sections on the form).
  •  
    Fax the completed form to 855-755-0518.
  •  
    A program representative will contact your office.

The information available here is compiled from sources believed to be accurate, but Merck makes no representation that it is accurate. This information is subject to change. Payer coding requirements may vary or change over time, so it is important to regularly check with each payer as to payer-specific requirements.

The information available here is not intended to be definitive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Merck and its agents make no warranties or guarantees, express or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs.

You are solely responsible for determining the appropriate codes and for any action you take in billing. Information about HCPCS codes is based on guidance issued by the Centers for Medicare & Medicaid Services applicable to Medicare Part B and may not apply to other public or private payers. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of a particular code and for information on additional codes. Diagnosis codes should be selected only by a health care professional.

Network Pharmacy Support

Network Pharmacy Support for Your Patients Prescribed SYLATRON

Select pharmacies that specialize in patient management are authorized to procure SYLATRON. Please download the list below for more information about the pharmacies within the limited distribution network.

DOWNLOAD THE
NETWORK PHARMACY LIST Download the Network Pharmacy List

For information on product returns, please call 800-611-7397.

The Merck Co-Pay Assistance Program

The Merck Co-Pay Assistance Program offers assistance to eligible patients if they need help affording certain prescribed medications.

 

Notice to Qualified Health Plans:

After careful consideration and deliberation, including analysis of the October 30, 2013, and February 6, 2014, letters from former Secretary Sebelius to Representative McDermott (D-WA) and Senator Grassley (R-IA), respectively, Merck has decided to make a co-payment assistance program for this product available to enrollees of a health insurance exchange established by a state government or the federal government who are not Medicaid-eligible. The terms and conditions of our patient co-payment assistance program are available through the link below.

The Merck Co-Pay Assistance Program is available for eligible patients.
Restrictions apply. See Terms and Conditions.

Co-pay assistance from the Merck Co-Pay Assistance Program is not insurance.

Is my patient eligible for the Merck Co-Pay Assistance Program for SYLATRON?

Co-pay assistance may be available for patients who

  •  Are at least 18 years old
  •  Are residents of the United States (including Puerto Rico)
  •  Have private health insurance that provides coverage for SYLATRON
  •  Have been prescribed SYLATRON for an FDA-approved indication
  •  Meet financial eligibility requirements as set forth in the Terms and Conditions
  •  Meet all other Terms and Conditions of the program
 

Patient and health care professional must submit all required information.
Please see the enrollment form for details.

The Co-Pay Assistance Program is not valid for patients covered under a Government Program, as that term is defined in the Terms and Conditions. The Co-Pay Assistance Program is not valid for uninsured patients.

What if my patient isn't eligible for the Merck Co-Pay Assistance Program?

Your patient may be able to get help from an independent co-pay assistance foundation. A Merck representative can provide you with information about independent foundations that may be able to provide financial support to patients who do not qualify for the Merck Co-Pay Assistance Program. Each independent foundation has its own eligibility criteria and application process.

We can help

Contact a representative for assistance. Representatives are available by calling
855-257-3932, Monday through Friday, 8 AM to 8 PM ET.

If your patient is eligible, getting started is simple

  •  
    Download and complete the enrollment form and please have the patient complete the appropriate sections on the form.
  •  
    Fax the completed form to 855-755-0518.
  •  
    A program representative will contact your patient and your office.
The Merck Patient Assistance Program

The Merck Patient Assistance Program provides certain Merck medicines free of charge to eligible patients.

Merck Access Program representatives can refer patients to the Merck Patient Assistance Program.


Who is the program for?

Patients who do not have insurance or whose insurance does not cover SYLATRON may be eligible for free product from the Merck Patient Assistance Program if they meet certain financial and medical criteria.

For more information on the program’s eligibility requirements, please visit www.merckhelps.com.

Getting started is simple

  •  
    Download and complete the appropriate sections of the enrollment form (if your patient is eligible and interested in co-pay assistance or the Merck Patient Assistance Program, please have the patient complete the appropriate sections on the form).
  •  
    Fax the completed form to 855-755-0518.
  •  
    A program representative will contact your patient and your office.
Contact The Merck Access Program | 855-257-3932
 
Contact The Merck Access Program
855-257-3932
Representatives are available Monday through Friday,
8 AM to 8 PM ET.
Ask to be contacted by a Field Reimbursement Associate | Call 855-257-3932
Call 855-257-3932
Ask to be contacted by a Field Reimbursement Associate
To request an appointment with a Nurse Educator, please call 855-257-3932
To request an appointment with a Nurse Educator, please call 855-257-3932
 
 

Merck Co-pay Assistance Program for SYLATRON (peginterferon alfa-2b) for injection
(Effective January 1, 2017)

TERMS AND CONDITIONS

  • To receive benefits under the Co-pay Assistance Program for SYLATRON (“Program Product”), the patient must enroll in the Co-pay Assistance Program and be accepted as eligible.
  • Patient must be prescribed the Program Product for an FDA-approved indication.
  • Patient must be 18 years of age or older and must have private health insurance that provides coverage for the cost of the Program Product purchased by the patient at an eligible participating pharmacy. Patient must have a maximum Annual Gross Household Income of less than or equal to 700% of the current Federal Poverty Level.
  • The Co-pay Assistance Program is not valid for patients covered under Medicaid (including Medicaid patients enrolled in a qualified health plan purchased through a health insurance exchange [marketplace] established by a state government or the federal government), Medicare, a Medicare Part D or Medicare Advantage plan (regardless of whether a specific prescription is covered), TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan (“Healthcare Reform”), or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program (collectively, “Government Programs”). The Co-pay Assistance Program is not valid for uninsured patients.
  • Patient must have an out-of-pocket cost for the Program Product and purchase the Program Product prior to the expiration date of the Co-Pay Assistance Program. Patient must pay the first $50 of co-pay on each prescription for Program Product (regardless of quantity supplied on the prescription). The benefit available under the Co-pay Assistance Program is limited to the amount of the patient’s actual out-of-pocket cost over $50, on each prescription, up to a maximum of $6,000 per patient, per calendar year (January 1 through December 31). The benefit available under the Co-pay Assistance Program is valid for the patient’s out-of-pocket cost for the Program Product only. It is not valid for any other out-of-pocket costs (for example, office visit charges or medication administration charges) even if such costs are associated with the administration of the Program Product.
  • Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the Co-pay Assistance Program. Patient is responsible for reporting receipt of Co-pay Assistance Program coupon benefits to any insurer, health plan, or other third party who pays for or reimburses any part of the medication cost paid for by the Co-pay Assistance Program, as required.
  • Co-pay Assistance Program Coupon can be redeemed only by eligible residents of the United States or the Commonwealth of Puerto Rico at participating eligible retain or mail-order pharmacies in the United States or the Commonwealth of Puerto Rico. Product must originate in the United States or the Commonwealth of Puerto Rico.
  • Co-Pay Assistance Program benefits are not available for patient costs incurred prior to the date the patient is determined to be eligible under and enrolled in the
    Co-Pay Assistance Program.
  • All information applicable to the Co-pay Assistance Program requested on the enrollment form must be provided, and all certifications must be signed. Forms that are modified or do not contain all the necessary information will not be eligible for benefits under the Co-pay Assistance Programs.
  • No other purchase is necessary.
  • The Co-Pay Assistance Program is not insurance.
  • The Co-Pay Assistance Program coupon may not be sold, purchased, traded, or counterfeited. Void if reproduced.
  • The Co-Pay Assistance Program is void where prohibited by law, taxed, or restricted. The Co-Pay Assistance Program is not transferable. No substitutions are permitted.
  • The Co-Pay Assistance Program coupon benefit cannot be combined with any other Co-Pay Assistance Program, free trial, discount, prescription savings card, or other offer.
  • Merck reserves the right to rescind, revoke, or amend the Co-Pay Assistance Program at any time without notice.
  • Co-Pay Assistance Program coupon is the property of Merck and must be turned in on request.
  • Data related to patient’s receipt of Co-pay Assistance Program benefits may be collected, analyzed, and shared with Merck, for market research and other purposes related to assessing Co-pay Assistance Programs. Data shared with Merck will be aggregated and de-identified, meaning it will be combined with data related to other Co-pay Assistance Program redemptions and will not identify patients.
  • Please read the accompanying Medication Guide and Instructions for Use for SYLATRON (peginterferon alfa-2b) for injection, including the information that SYLATRON can cause serious mental health problems which can lead to suicide, and discuss them with your doctor. The physician Prescribing Information also is included.
  • Expiration Date: 12/31/2017

ONCO-1198306-0000 10/16