The Merck Access Program (MAP) may be able to answer questions about:
MAP can contact insurers to request coverage and beneﬁts information. Visit the speciﬁc product site for additional resources.
If a prior authorization is required, or for assistance in understanding if a prior authorization is required, MAP may be able to help.
The prior authorization checklist and sample letter can help you to understand the documents and information that may be helpful when seeking
a prior authorization. As always, you should check for payer-speciﬁc requirements.
If you have submitted a claim and the claim has been denied, you can submit an appeal to your patient’s insurer.
MAP may be able to help your ofﬁce understand the information needed for an appeal submission.
The appeal checklist and sample appeal letter can help you to understand the documents and information that may be helpful when ﬁling an appeal.
As always, you should check for payer-speciﬁc requirements.
The Merck Co-pay Assistance Program
The Merck Co-pay Assistance Program offers assistance to eligible privately insured patients who need help affording the out-of-pocket costs
for their medication.
Co-pay assistance from the Merck Co-pay Assistance Program is not insurance. Restrictions apply. See the Terms and Conditions for the applicable
Patient and health care professional must submit all required information. Please see the enrollment form for the applicable product for details.
Independent Assistance Foundations
Your patients may also be able to get help from an independent assistance foundation. Independent assistance foundations may be able to help
patients who are encountering hardships affording their prescribed medications or who do not qualify for other forms of ﬁnancial support. Each
foundation determines its own eligibility criteria and application process and is independent from Merck; there is no guarantee a patient will receive
any type of assistance from these organizations.
The Merck Patient Assistance Program
MAP representatives can refer patients to the Merck Patient Assistance Program for eligibility determination (provided through the Merck Patient
Assistance Program, Inc.)
Getting started is simple
Billing and Coding
MAP provides billing and coding information that may be relevant for your patient’s medication and its administration. Ofﬁce staff may call MAP
with speciﬁc questions about codes that may be relevant when billing for the medication and its administration.
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.