| Pharmaceutical Company |
Merck & Company , Inc. |
| Program Name |
Zetia Patient Assistance Program |
| Program Address |
PO Box 690 Horsham, PA 19044-0365 |
| Medicines On Program |
Zetia Tablets 10mg |
| Phone Number |
800-347-7503 |
| Fax Number |
Not Applicable |
| Application |
Contact program for application |
| Guidelines and Notes |
The program is only available to patients who live in the US and have a prescription for the medication from a US-licensed doctor. The patient cannot have any insurance coverage and have an income at or below $18,000 for an individual and $24,000 for a couple. Patients with income above the guidelines should still apply. |
| Initiating Enrollment |
Anyone can call for an application, it will be mailed out. The application sent in must be an original, it can not be copied. The completed application must be mailed in. |
| Health Provider's Role |
The physician must fill out two sections, one of which is a prescription built into the application. The physician must also sign the application (no stamps accepted.) The prescription should be made out for a 90 day supply with 3 refills. |
| Patient's Role |
The patient must fill a section that include questions about annual household income, insurance and sign the application. |
| How Dispensed |
The medication can be sent to the physicians office or the patient's home. |
| Amount Dispensed |
A 90 day supply is sent out. |
| Refills |
To get the refills, someone must call the company. After one year a new application is needed. |
| Limit |
Indefinitely |