rxhelp360.org
| Program Contact Info / Application Submission | ||||||||||
| Program | ACT (Accessing Coverage Today) for EMEND | |||||||||
| Company | Merck & Company, Inc. | |||||||||
| Form | Download PDF | |||||||||
| Address | PO Box 18979 Louisville, KY 40261-0979 | |||||||||
| Phone | 1-866-363-6379 (open M-F 8-8 EST) | |||||||||
| Fax | 1-866-363-6389 | |||||||||
| Website | www.emend.com/aprepitant/emend/hcp/managed_care_info/index.jsp | |||||||||
| Program Details | ||||||||||
| Details | Patients in need who appear not to qualify should still call. Must send in new application every 12 months. | |||||||||
| Program Requirements | ||||||||||
| Information | Doctor and patient must fill out respective portions of the application. NO separate prescription is required. | |||||||||
| Delivery of Medication | ||||||||||
| Ship Time | 48-72 hours | |||||||||
| Delivery Options | Can NOT be delivered directly to the patient Can NOT be delivered directly to the doctor | |||||||||
| Application Process | ||||||||||
| App Process | Both the patient and doctor will be notified of acceptance into the program. | |||||||||
| New Applications | New applications NOT accepted Patients can NOT apply directly to the program Doctors can NOT apply directly to the program Advocates can NOT apply directly to the program Can NOT apply for a new application via phone Can NOT apply for a new application via fax Can NOT apply for a new application via mail | |||||||||
| Refills | Refills NOT accepted Patients can NOT apply for refills Doctors can NOT apply for refills Advocates can NOT apply for refills | |||||||||
| Eligibility | ||||||||||
| Eligibility | The patient must not have insurance or other coverage options for EMEND. The Patient must not be able to afford to pay for EMEND, based on established criteria and the applicant's financial situation. Eligibility criteria will be based on the patient's net household income, geographic location, the number of people in the household, and the household out-of-pocket medical expenses (that are deducted from net income). The patient must live in the United States (but does not have to be a US citizen) and have a prescription for EMEND from a healthcare professional licensed in the United States. | |||||||||
| Other Medications | ||||||||||
| Other Medications available in this program |
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