Patient Assistance Programs

: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Zinplava. 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 Zinplava

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

Provided by: Merck Patient Assistance, Inc.
Merck Access Program PO Box 29067 Phoenix, AZ 85038
TEL: 877-709-4455
FAX: 800-977-1957
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Zinplava (bezlotoxumab)
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 Doctor's office or specific site
  • Delivery Time Not specified
  • Refill Proces Not specified
  • 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 November 9, 2018

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Merck Connect

(Program of 2 — 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
  • Zinplava (bezlotoxumab)
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 November 9, 2018

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