Zerbaxa

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

About This Program

The Merck Patient Assistance Program (Merck PAP) is designed to help uninsured and indigent patients access Merck medications, including Zerbaxa (ceftolozane/tazobactam), at no cost. Zerbaxa is an antibiotic combination used to treat complicated urinary tract infections and complicated intra-abdominal infections caused by susceptible bacteria. If you cannot afford your prescribed Zerbaxa, this program may be able to help.

Who Qualifies for Merck PAP

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

• US Residency: You must currently reside in the United States or a US territory (you do not need to be a US citizen)
• Valid Prescription: A licensed US healthcare provider must have prescribed you Zerbaxa
• Insurance Status: You must be uninsured or indigent. Patients with certain insurance plans—particularly those involving alternative funding programs that require or encourage PAP enrollment as a condition—are not eligible
• Financial Need: You must meet the program's financial eligibility criteria, which are designed for patients with limited income and resources

Income Eligibility

The Merck PAP uses financial criteria to determine eligibility, though specific income thresholds are not publicly listed. The program is specifically designed for indigent and uninsured patients. Your household income and current insurance status will be evaluated during the application process.

If you authorize the program, Merck PAP can conduct an electronic income verification through a consumer report, which will not affect your credit rating. Alternatively, you can provide one of the following documents as proof of household income:

• Recent tax return
• Pay stubs
• Proof of unemployment or disability benefits
• Bank statements
• Other documentation of household financial status

Insurance Requirements

You are eligible for Merck PAP if you:

• Have no insurance coverage for Zerbaxa, OR
• Are enrolled in certain insurance plans that do not cover this medication

You are NOT eligible if:

• Your insurance plan participates in or is involved with an alternative funding program that requires or encourages you to apply to Merck PAP as a condition of coverage
• Your employer offers coverage through a plan with such alternative funding arrangements

If you have Medicare, Medicaid, or private insurance that covers Zerbaxa, you may not qualify unless your plan specifically excludes this medication.

How to Apply: Step-by-Step

Step 1: Call to Request an Application

Contact the Merck Patient Assistance Program by phone:

Phone: (888) 727-9535

A program representative will answer your questions and can mail or email you an enrollment form. You can also download the form from MerckHelps.com.

Step 2: Complete Your Section of the Application

Fill out all sections of the enrollment form that apply to you (typically Section 1, and sign Sections 2 and 3). You can:

• Fill in the form online and print it, OR
• Print the form and complete it by hand using a black ballpoint pen

Make sure to include:

• Your full name and contact information
• Your household income information
• Authorization for income verification (either electronic or by providing supporting documents)
• Your signature and date in all designated areas

Step 3: Have Your Healthcare Provider Complete Their Section

Give the partially completed form to your prescribing healthcare provider. They must:

• Complete Section 4 and Section 5 of the enrollment form
• Include their National Provider Identifier (NPI) number
• Sign and date all designated areas
• For controlled substances, provide a separate prescription written according to state dispensing laws

Step 4: Submit Your Completed Application

Once both you and your healthcare provider have completed, signed, and dated all sections, submit the original form by:

• Faxing to the Merck PAP fax number (provided on the form), OR
• Mailing to the Merck Patient Assistance Program address (listed on the form)

Keep a copy for your records.

Step 5: Receive Approval Notification

If you provided your email address on the application, you will receive an email confirming that Merck PAP received your enrollment form. You will be notified of your eligibility status once the program completes its review.

Processing Timeline

The Merck Patient Assistance Program typically processes completed enrollment forms within 2-3 business days if:

• All fields are completely filled out
• All signature fields are signed and dated
• You are eligible for the program
• All required documentation is included

Processing times may be longer if your form is incomplete or if additional information is needed. For urgent medication needs, call the program directly at (888) 727-9535 to discuss expedited options.

What Happens After Approval

Once approved, the Merck PAP will arrange for your Zerbaxa to be provided at no cost. The program will work with your healthcare provider and pharmacy to ensure you receive your medication. Each application is valid for up to 12 months; after that time, you may need to reapply if you continue to meet eligibility criteria.

What If Your Application Is Denied

If you are not approved for Merck PAP, the program will provide information about why you were not eligible. Common reasons include:

• Having insurance coverage for Zerbaxa
• Not meeting the financial eligibility criteria
• Enrollment in an alternative funding program
• Incomplete application information

If denied, ask the program about:

• Whether you can reapply if your circumstances change
• Other patient assistance resources
• Whether your healthcare provider can help you explore other options
• Manufacturer rebate programs or other cost-reduction strategies

Important Reminders

• A separate application is required for each patient
• You must have a valid prescription from a US-licensed healthcare provider
• The program requires authorization to share your medical and financial information with healthcare providers, pharmacies, and health plans to administer the program
• This program is for patients who cannot otherwise afford their medication

Contact Information

Merck Patient Assistance Program

Phone: (888) 727-9535

Website: MerckHelps.com

Hours: Monday–Friday, 8 AM–8 PM ET

Disclaimer

This guide provides general information about the Merck Patient Assistance Program for Zerbaxa. Eligibility requirements, application procedures, and program terms are subject to change. For the most current and complete information, contact the Merck Patient Assistance Program directly or visit MerckHelps.com. This guide is not a guarantee of program enrollment or medication provision. Always consult with your healthcare provider about your treatment options and medication access.