Electronic Enrollment

The Merck Access Program Electronic Enrollment Form

This form can be signed and submitted electronically.


The Merck Access Program Enrollment Form

Coding and billing resources

Billing and Coding Card
Sample CMS-1500 Form
Sample UB-04 Form

Patient support materials

Product information

Prescribing 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, 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 billing codes is based on publicly available guidance and may not apply to all 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.

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