Family Size
 100%
 133%
 150%
 200%
 250%
 300%
1
 $10,400
 $13,382
 $15,600
 $20,800
 $26,000
 $31,200
2
 $14,000
 $18,620
 $21,000
 $28,000
 $35,000
 $42,000
3
 $17,600
 $23,408
 $26,400
 $35,200
 $44,000
 $52,800
4
 $21,200
 $28,196
 $31,800
 $42,400
 $53,000
 $63,000
5
 $24,800
 $32,984
 $37,000
 $49,600
 $62,000
 $74,400
6
 $28,400
 $37,772
 $42,600
 $56,800
 $71,000
 $85,200
7
 $32,000
 $42,560
 $48,000
 $64,000
 $80,000
 $96,000
8
 $35,600
 $47,348
 $48,000
 $64,000
 $80,000
 106,800
For each
additional
family member
$3,600
$4,788
$5,400
$7,200
$9,000
$10,800
Patient assistance programs (PAPs) are programs created by drug companies, such as MERCK & COMPANY,
INC., to offer free or low cost drugs to individuals who are unable to pay for their medication.  These Programs may
also be called indigent drug programs, charitable drug programs or medication assistance programs.  Most of the
best known and most prescribed drugs can be found in these programs.  All of the major drug companies have
patient assistance programs, although every company has different eligibility and application requirements.

Merck & Company, Inc. pride themselves at providing their products to over 200 countries world wide. Along with
their extensive product line, Merck & Company, Inc. provides not-for-profit services including their publication of
unbiased health information.

Patient Assistance Program

The medications available through this program are:

Cosopt - dorzolamide hydrochloride-timolol maleate ophthalmic solution
Cozaar - losartan potassium
Hyzaar - antihypertensive combinations
Janumet - sitagliptin/metformin HCL
Januvia - sitagliptin phosphate
Maxalt - rizatriptan benzoate
Maxalt-MLT - rizatriptan benzoate
Singulair - montelukast sodium
Timoptic-XE - timolol maleate
Trusopt - dorzolamide HCL

Eligibility

Merck Patient Assistance Program, the core patient assistance program provided by Merck & Company, Inc.,
offers the medications listed to the right at no cost to those who are eligible for the program. Eligibility is based off
of the following requirements:

  • You must be a resident of the United States or it's Territories.

  • You must have not be covered by private or public health insurance.

  • Your income must be less than 200% of the Federal Poverty Guideline for the size of your household (see
    chart below).

  • Medicare Part D patients might be eligible but must go through an appeals process once denied.


SOURCE: 2008 Poverty Chart





















What’s Next?

Fill out the program enrollment form located below. After filling out the enrollment form please bring the form to
your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your
application to the program.

Merck Patient Assistance Enrollment Form with Instructions


Please click here to go to the program website for more information