RxAssist Home
RxAssist Home Home  |  About Us  |  Contact RxAssist          
      Patient Assistance Program Center
 
 

Program Details

MERCK & COMPANY, INC.
The Merck Patient Assistance Program

Januvia (sitagliptin phosphate)
 
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
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    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: 11/21/2023

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)


    Document Form (Spanish)


    Document HIV Common Application



     

    Print-friendly version

    This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. Neither RxAssist nor RxVantage is offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Neither RxVantage nor RxAssist provide any warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment. Third party logos, trademarks, brand names and images contained on rxassist.org or rxvantage.com are for demonstration purposes only and are owned by their respective rights holders, who are not affiliated with this Site.

    Copyright © 2024, RxVantage, all rights reserved.