Januvia

Indicated For

Type 2 diabetes

About This Medication

# Merck Patient Assistance Program Patient Guide: How to Get Januvia at Low or No Cost ## About This Program The **Merck Patient Assistance Program** provides free or low-cost Januvia (sitagliptin phosphate) to eligible patients who cannot afford their medication. Januvia is a prescription diabetes medication used to help control blood sugar levels in adults with type 2 diabetes. If you have been prescribed Januvia and meet the program's eligibility requirements, you may receive your medication at no cost. ## Who Qualifies for This Program To be eligible for the Merck Patient Assistance Program, you must meet **all three** of the following conditions: 1. **You are a US resident** with a valid prescription for Januvia from a licensed US healthcare provider. You do not need to be a US citizen; residents of US territories are also eligible. 2. **You have no insurance or other coverage** for your prescription medication. This includes private insurance, HMOs, Medicaid, Medicare, state pharmacy assistance programs, Veterans' assistance, or any other social service agency support. If you have insurance but face special circumstances of financial and medical hardship, you may request an exception. 3. **Your household income is at or below the program's income limits** (see Income Eligibility section below). ## Income Eligibility Breakdown The Merck Patient Assistance Program uses income thresholds based on 400% of the Federal Poverty Level (FPL). Your household income must not exceed the following amounts: | Household Size | Maximum Annual Income | |---|---| | Individual | $60,780 | | Couple | $60,780 | | Family of 3+ | 400% FPL (varies by year) | These income limits are updated annually. If your income is slightly above these thresholds but you face significant financial or medical hardship, you can request an exception to the income requirement. ## Insurance Requirements and Medicare The program requires that you **do not have active insurance coverage** for prescription medications. However, **Medicare Part D patients may be eligible**—contact the program directly at 1-800-727-5400 to discuss your specific situation. If you have insurance through an employer, private plan, Medicaid, or other coverage, you typically will not qualify unless you can demonstrate special circumstances of financial and medical hardship that warrant an exception. ## How to Apply: Step-by-Step ### Step 1: Obtain the Application Form You can get the enrollment form in three ways: - **Call** 1-800-727-5400 (8 AM to 8 PM ET) to request a form by mail - **Download** the form from MerckHelps.com - **Contact** your healthcare provider's office, as they may have forms available ### Step 2: Complete Your Information Fill out **all sections** of the enrollment form completely. You can: - Fill in the fields online and print the form, OR - Print the form and complete it by hand using a black ballpoint pen Incomplete forms will be returned, so ensure every field is filled in accurately. ### Step 3: Visit Your Healthcare Provider Take the completed form to your physician or prescriber. **Both you and your healthcare provider must sign and date the form** in all designated places. This is a required step—the application cannot be processed without both signatures. ### Step 4: Provider Writes Your Prescription Your healthcare provider will write your Januvia prescription directly in **Section 4 of the enrollment form**. They do not need to write a separate prescription. A single form can include prescriptions for up to 3 Merck medicines. ### Step 5: Submit Your Application Mail your completed and signed enrollment form to: **Merck Patient Assistance Program** PO Box 1206 Wilkes Barre, PA 18703-1206 Note: Applications cannot be submitted by fax or email. ## Timeline and Medication Delivery **Processing Time:** Your application will typically be processed within **0-1 week** of receipt. **Medication Delivery:** Your medication will be shipped to your home address unless your healthcare provider requests otherwise in Section 1 of the application. **Prescription Supply:** Each prescription can provide up to a 90-day supply of medication with a maximum of 3 refills. Your enrollment form remains valid for up to 12 months; after that, you will need to submit a new application. ## Refills and Reauthorization When you need a refill, **you must contact the Merck Patient Assistance Program** directly at 1-800-727-5400 to request it. You are entitled to up to 3 refills per enrollment form. **After 12 months**, your enrollment expires and you will need to submit a new application form with updated information and signatures from both you and your healthcare provider. ## What If Your Application Is Denied If your application is denied, you have several options: - **Request an exception:** If you believe you have special circumstances of financial or medical hardship, you can request that an exception be made to the eligibility criteria. - **Reapply:** You can submit a new application if your circumstances change (such as a decrease in income or loss of insurance). - **Contact the program:** Call 1-800-727-5400 to discuss your situation and explore other assistance options. - **Explore alternatives:** Ask your healthcare provider about generic versions of sitagliptin or other diabetes medications that may be more affordable. ## Important Reminders - **Incomplete applications will be returned.** Double-check that all fields are completed before submitting. - **Both signatures are required.** Your application cannot be processed without signatures from both you and your healthcare provider. - **Annual reauthorization is necessary.** Plan to reapply after 12 months to continue receiving medication. - **Contact the program with questions.** The Merck Patient Assistance Program team is available at 1-800-727-5400 (8 AM to 8 PM ET) to answer questions about eligibility, the application process, or your account. ## Disclaimer This guide provides general information about the Merck Patient Assistance Program for Januvia. Program eligibility, income limits, and requirements may change. For the most current and complete information, visit MerckHelps.com or call 1-800-727-5400. Always consult with your healthcare provider about your medication and treatment options.

Program information last verified: March 25, 2026