Program Details

MERCK & COMPANY, INC.
The Merck Patient Assistance Program
Proventil HFA Inhaler (albuterol)
 
CONTACT INFO
Address: PO Box 690
Horsham, PA 19044-9979
Phone: 1-800-727-5400 Provider Phone:
Fax: Website: The Merck Patient Assistance Program
ELIGIBILITY
Eligibility Info:
  • Patients must not have insurance or other coverage for your prescription medicine, including private insurance, Medicare, Medicaid, HMOs, state pharmacy assistance programs, Veterans' assistance programs, or any other social service agencies.
  • If you do not meet the income or prescription drug coverage criteria, your income is below a set upper limit, and there are special circumstances of financial and medical hardship that apply to your situation, you can request that an exception be made for you.
  • Medicare Part D patients might be eligible, contact program for details.
    		•
    Income at or below: Single 400 % FPL
      Couple 400 % FPL
    Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: None
    Physician License #
    Required:    		 State
    Prescriber Signature
    Allowed:    		 Physician
    PA
    Application may be
    faxed:    		 No
    Eligibility determination
    letter sent:    		 Not Published
    MEDICATION
    Receives: Medication
    Shipped To: Either Provider and Patient
    Quantity in Shipment: 90 days
    Delivery Time: 0-1 week
    Re-application Policy: New application every 12 months
    Refill Policy: 3 refills
    Patient must contact program for refills
    Other Information:

    Last Updated: 04/04/2024


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