Prevymis Prescription Assistance Programs

Prevymis: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Prevymis. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Merck Access Program for Prevymis

(Program 1 of 3 — Scroll down to see them all )

Provided by: Merck Patient Assistance, Inc.
Merck Access Program PO Box 29067 Phoenix, AZ 85038
TEL: 855-404-5278
FAX: 866-866-4127
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Prevymis (letermovir)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Contact program for details.
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must be residing in the US or a US territory, and under the care of a US physician
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Not specified
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Patient must contact company
  • Limit Not specified
  • Re-application New application yearly
Additional Information
Patient must sign the enrollment form to give the program permission to access their financial information in order to determine eligibility. Patients in need who appear not to qualify should still call.
Updated July 3, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

Back to top

Merck Connect

(Program 2 of 3 — Scroll down to see them all )

Provided by: Merck & Co., Inc.
None
TEL: 800-489-5119
Languages Spoken:
English
Program Website
Program Applications and Forms
Medications
  • Prevymis (letermovir)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Determined case by case
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
  • U.S. Residency Required? Must be treated by US licensed healthcare provider
Application
  • Obtaining Enroll online
  • Receiving Not specified
  • Returning The completed application's destination is not specified
  • Doctor's Action Enroll in the program
  • Applicant's Action Inform Doctor that he/she is in need
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Up to 30 day supply
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Not specified
Additional Information
Resources for HEALTHCARE PROFESSIONALS ONLY. The Physician must register to access tools and materials for patient support, product sample requests, up-to-date professional resources, and other Merck professional sites.
Updated July 2, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

Back to top

HealthWell Foundation Copay Program

(Program 3 of 3 — Scroll down to see them all )

Provided by: HealthWell Foundation
P.O. Box 489 Buckeystown, MD 21717
TEL: 800-675-8416
FAX: 800-282-7692
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Prevymis (letermovir)
Eligibility Requirements
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income Varies
  • Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
  • U.S. Residency Required? The patient must also be residing in the US.
Application
  • Obtaining Call or complete online
  • Receiving Sent out or may be completed online
  • Returning The completed application must be mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient notified in writing
  • Decision Timeframe 3-5 business days
Medication
  • Amount/Supply Not applicable
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Good for one year
  • Limit Not specified
  • Re-application New application every 12 months
Additional Information
This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change.
Updated July 2, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

Back to top