Program Details

MERCK & COMPANY, INC.
Merck Vaccine Patient Assistance Program
Vaqta (Hepatitis A vaccine, inactivated)
 
CONTACT INFO
Address:
,
Phone: 1-800-293-3881 Provider Phone:
Fax: 1-800-528-2551 Website: Merck Vaccine Program Website
ELIGIBILITY
Eligibility Info:
  • Patient must be a US resident and be at least 19 years old.
  • Patient must not have health insurance coverage. However, individuals who don't meet the insurance criteria may still qualify for the Merck Patient Assistance Program if they attest that they have special circumstances of financial and medical hardship, and their income meets the program criteria.
    		•
    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: No
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: None
    Physician License #
    Required:    		 State
    Prescriber Signature
    Allowed:    		 Physician
    Application may be
    faxed:    		 Yes
    Eligibility determination
    letter sent:    		 Determination is made within 10 - 15 minutes within receipt of faxed application.
    MEDICATION
    Receives: Medication
    Shipped To: Provider
    Quantity in Shipment:
    Delivery Time: 0-1 week
    Re-application Policy:
  • A new application will need to be completed and submitted to the Merck Vaccine Patient Assistance Program for eligibility assessment prior to a patient receiving a subsequent dose in a multi-dose series or for another Merck vaccine.
    • Refill Policy:
    Other Information:

    Last Updated: 04/04/2024


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