Resources
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The Merck Patient Assistance Program
Enrollment Form for the Merck Patient Assistance Program
(Download, print, and fax completed form)
Coverage and Reimbursement Support
Prior Authorization Checklist
Sample Prior Authorization Letter
Appeal Checklist
Sample Appeal Letter
Product Information
Prescribing Information
Instructions for Use
Patient Information

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, expressed 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 Healthcare Common
Procedure Coding System 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.