RECOMBIVAX HB®
[Hepatitis B Vaccine (Recombinant)]
This private and confidential program provides
vaccines 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.
Who May Qualify
You may be eligible for the program if all 3 of the following conditions apply:
-
You reside in the United States and are age 19 or older(1)
AND
-
You do not have insurance or other coverage for your prescription medicine. Some examples of other insurance coverage include private insurance, HMOs, Medicaid, Medicare, state pharmacy assistance programs, veterans assistance, or any other social service agency support.(2)
AND
-
You have an annual household income less than(3):
- $62,600 or less for individuals
- $84,600 or less for couples
- $128,600 or less for a family of 4.
(1) You do not have to be a US citizen. Residents of the United States, including US Territories, are also eligible.
(2) If you do not meet the insurance coverage criteria, your income meets the program criteria, and there are special circumstances of financial and medical hardship that apply to your situation, you can request that an exception be made for you. Patients may not have an insurance plan or employer that participates in or are involved in any way with an alternative funding program that requires or encourages you to apply to the Merck Patient Assistance Program as a condition, requirement, or prerequisite for coverage of specific Merck medications.
(3) For income limits in Alaska and Hawaii, please call 1-800-727-5400.
How to Get Started
Patients should speak with their health care professional about which vaccines may be right for them.
To participate in the program, patients and their licensed prescribers (eg, physicians, nurse practitioners, and physician assistants) must:
Complete and sign an enrollment form — available for download on the right (English or Spanish).
Fax completed form from a participating Licensed Prescriber's Office to 800-528-2551.
The enrollment form must be submitted and approved prior to administration of vaccine in order to qualify.
Forms will be processed quickly* — with a goal of less than 10 minutes — and the Licensed Prescriber's Office will be notified by phone so that qualifying patients can receive the Merck vaccine during that visit.
A new application will need to be completed and submitted to the Merck Vaccine Patient Assistance Program for eligibility assessment prior to a patient receiving a subsequent dose in a multidose series or for another Merck vaccine.
* During business hours (8 AM – 8 PM ET, Monday – Friday)
Check Your Eligibility
Download Enrollment Form (Application)
Enrollment Options
You may have your enrollment form faxed to 1-800-528-2551.
Print and Fax
Fax Enrollment Application Form to:
1-800-528-2551
Need Assistance?
- For additional help on how to complete Enrollment Application forms, please visit our resources.
- You can contact a support representative at 800-293-3881, Monday through Friday, from 8 AM – 8 PM ET.