(raltegravir) 400 mg film-coated and 25 mg and 100 mg chewable Tablets
This product qualifies for the SUPPORT™ Program. This private and confidential program provides product free of charge to eligible individuals, primarily the uninsured who, without our assistance, could not afford needed Merck medicines. Individuals who don’t meet the insurance criteria may still qualify for this program if they attest that they have special circumstances of financial and medical hardship, and their income meets the program criteria. A single application may provide for up to 1 year of product free of charge to eligible individuals and an individual may reapply as many times as needed.
Who May Qualify
Patient Assistance for Eligible Patients
You may qualify for patient assistance through the SUPPORT™ Program if you have been prescribed ISENTRESS® (raltegravir) Tablets or CRIXIVAN® (indinavir sulfate) Capsules and all 3 of the following conditions apply:
You are a US resident and have a prescription for ISENTRESS or CRIXIVAN from a health care provider licensed in the United States.*
You do not have insurance or other coverage options for ISENTRESS or CRIXIVAN.
You cannot afford to pay for ISENTRESS or CRIXIVAN. You may be eligible for the patient assistance program if you have a household income of $60,300 or less for individuals, $81,200 or less for couples, or $123,000 or less for a family of 4.†
Referrals from the SUPPORT™ Program to the Merck Patient Assistance Program are primarily designed to help those who do not have insurance coverage; however, if you have insurance, including if you are in Medicare Part D, but still have trouble paying for your medicines, you may request that an exception be made for you, provided that your income is not above a set limit.
* You do not have to be a US citizen. Legal residents of the United States, including US Territories, are also eligible.
† For income limits in Alaska and Hawaii, please call 1-800-727-5400.
How to Get Started
You can start the enrollment process by phone, by fax, or by mail. A complete enrollment form is required. Enrollment forms are available on this Web site or by calling 1-800-850-3430.
- Call 1-800-850-3430, 9 AM to 6 PM EST, Monday through Friday, and a SUPPORT™ Program Specialist will begin the enrollment process.
- Complete and sign an enrollment form (available on the right for download).
- All sections on the enrollment form need to be completed and both you and your health care provider must sign the form.
- Incomplete or incorrectly completed enrollment forms will slow down the processing of your request.
- Fax the completed enrollment form to
Once you have completed and signed the enrollment form (available on the right for download), simply fold it and mail it to the following address:
PO Box 305
San Bruno, CA 94066-9901
For those who qualify for patient assistance:
Quick Shipment: ISENTRESS® (raltegravir) Tablets or CRIXIVAN® (indinavir sulfate) Capsules can be shipped directly to your home unless you and your health care provider specify that your prescribed ISENTRESS or CRIXIVAN be sent to his or her office. There is a 24-hour emergency shipment service available if needed.
Refills: A single enrollment form covers the prescription and refills.