Prevymis Patient 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 1 — 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
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 treated by US licensed healthcare provider
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 20, 2018

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

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