Zepatier

Merck Patient Assistance Program Patient Guide: How to Get Zepatier at Low or No Cost

About This Program

The Merck Patient Assistance Program (Merck PAP) is a free medication assistance program designed to help uninsured and underinsured patients access Merck medications, including Zepatier (elbasvir/grazoprevir), at no cost. This program ensures that financial barriers do not prevent you from receiving the hepatitis C treatment your healthcare provider has prescribed.

About Zepatier

Zepatier is a direct-acting antiviral combination medication used to treat chronic hepatitis C virus (HCV) infection. It works by targeting specific proteins that the hepatitis C virus needs to replicate, helping to cure the infection. Your healthcare provider has determined that Zepatier is the appropriate treatment for your condition.

Who Qualifies for Merck PAP?

To be eligible for the Merck Patient Assistance Program, you must meet ALL of the following requirements:

• U.S. Residency: You must currently reside in the United States or a U.S. territory (you do not need to be a U.S. citizen)
• Valid Prescription: A licensed healthcare provider must have prescribed you Zepatier
• Insurance Status: You must be primarily uninsured, or in special circumstances, you may qualify if you have insurance but face financial hardship
• Financial Need: You must meet the program's financial eligibility criteria based on your household income
• No Alternative Funding: You cannot have an insurance plan or employer program that requires or encourages you to apply to Merck PAP as a condition of coverage

Income Eligibility

The Merck Patient Assistance Program evaluates financial need on a case-by-case basis. While specific income thresholds are not publicly listed, the program primarily serves uninsured patients and considers special circumstances for those with insurance. The program uses a financial assessment process that may include:

If you are unsure whether you qualify based on income, the program encourages you to apply or call for a preliminary eligibility check.

Insurance Requirements

Uninsured Patients: You are the primary focus of this program and have the strongest eligibility.

Insured Patients: If you have insurance, you may still qualify under special circumstances, such as:

• High out-of-pocket costs or high deductibles
• Insurance denial of coverage for Zepatier
• Documented financial hardship

Important: You cannot participate in Merck PAP if your insurance plan or employer program requires or encourages you to apply to Merck PAP as a condition of receiving benefits.

Step-by-Step Application Process

Step 1: Download and Complete Your Application

1. Visit merckhelps.com or call 1-800-727-5400 to download the Merck Patient Assistance Program enrollment form
2. Print the form or complete it online and then print it
3. Complete Section 1 of the enrollment form with your personal information:
   • Full name
   • Date of birth
   • Current address and phone number
   • Household income information
   • Insurance status
4. Sign and date Sections 2 and 3 in all designated areas
5. Include proof of your financial need by either:
   • Authorizing the program to conduct a credit report verification (this will NOT affect your credit rating), OR
   • Providing one document from the list on the application cover page showing proof of household income or residency (such as a recent tax return, utility bill, or pay stub)

Step 2: Have Your Healthcare Provider Complete the Application

1. Bring the completed application to your healthcare provider
2. Your healthcare provider must:
   • Complete Section 4 of the enrollment form
   • Complete and sign Section 5, including their National Provider Identifier (NPI) number
   • Sign and date all designated areas
   • Provide a valid prescription for Zepatier (controlled substance prescriptions must be written separately from the enrollment form per state law)

Step 3: Submit Your Application

Mail the original signed enrollment form to:

Merck Patient Assistance Program PO Box 1206 Wilkes Barre, PA 18703-1206

Important: Only original signed forms are accepted; copies will not be processed.

Step 4: Receive Your Medication

Once approved, Zepatier will be shipped directly to you or your healthcare provider's office at no cost.

Application Timeline and Processing

Processing Time: The Merck Patient Assistance Program typically processes fully completed enrollment forms within 2-3 business days if you are eligible. Some sources indicate processing can occur in less than 7 business days.

Timeframe Variations: Processing may take longer if:

• Your enrollment form is incomplete
• Additional information or documentation is required
• The program needs to verify your eligibility

Urgent Needs: If you have an urgent medical need, call 1-800-727-5400 to speak with a program representative who may be able to expedite your application.

What Happens If Your Application Is Denied?

If your application for Merck PAP is denied, you have several options:

1. Request Clarification: Call 1-800-727-5400 to understand why your application was denied and whether you can provide additional information
2. Reapply: If your circumstances change (such as loss of insurance or change in income), you may reapply with updated information
3. Explore Other Resources: Ask your healthcare provider about:
   • Other patient assistance programs
   • State pharmaceutical assistance programs
   • Non-profit organizations that help with hepatitis C treatment costs
   • Clinical trials that may provide free medication
4. Insurance Appeals: If you have insurance, work with your provider to appeal any coverage denials

Reauthorization and Refills

Each Merck PAP enrollment is valid for up to 12 months. After 12 months, you will need to submit a new application if you require additional medication. Under certain circumstances, enrollment may be limited to a calendar year.

Important Reminders

• Original Forms Only: Mail only the original signed enrollment form; copies will not be accepted
• Both Signatures Required: Both you and your healthcare provider must sign and date all designated areas
• Complete All Sections: Incomplete applications will delay processing
• Periodic Audits: The program reserves the right to conduct periodic audits and request documentation to verify the information you provided
• One Application Per Patient: A separate application is required for each patient

Contact Information

Merck Patient Assistance Program

• Phone: 1-800-727-5400
• Website: merckhelps.com
• Mailing Address: PO Box 1206, Wilkes Barre, PA 18703-1206

Disclaimer

This guide provides general information about the Merck Patient Assistance Program. Program eligibility, requirements, and benefits are subject to change. For the most current and complete information, visit merckhelps.com or call 1-800-727-5400. This guide is not a substitute for official program documentation or professional medical advice. Always consult with your healthcare provider regarding your treatment options and eligibility for assistance programs.