WELIREG prescriptions can be filled through EITHER the specialty pharmacy network or certain physician practices with dispensing capabilities and certain hospital pharmacies.
THE MERCK ACCESS PROGRAM MAY BE ABLE TO HELP ANSWER QUESTIONS ABOUT:
THE MERCK ACCESS PROGRAM MAY BE ABLE TO HELP ANSWER QUESTIONS ABOUT:
- Benefits investigations
- Prior authorizations and appeals
- Potential financial assistance options for eligible patients, including information about co-pay assistance for eligible, privately insured patients
- Referral to the Merck Patient Assistance Program for eligibility determination (provided through the Merck Patient Assistance Program, Inc.)
Learn More About Enrollment
Please click on the links below to access The Merck Access Program forms that are applicable to you. If your patient is requesting a referral to the Merck Patient Assistance Program, be sure to include all information, including a prescription for WELIREG. Please be sure all signatures are included prior to submitting forms to The Merck Access Program.
ENROLLMENT SUPPORT
Sample Enrollment Form
This form is a helpful resource that outlines important details and steps while you are filling out the enrollment form to ensure that all information and signatures are captured.
Submit Documents
Use this link to securely upload documents to submit to The Merck Access Program.
