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Program Details
MERCK & COMPANY, INC.
The Merck Patient Assistance Program
Singulair
(montelukast sodium)
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| ELIGIBILITY
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| Eligibility
Info: |
Patients must not have insurance or other coverage for your prescription medicine, including private insurance, Medicare, Medicaid, HMOs, state pharmacy assistance programs, Veterans' assistance programs, or any other social service agencies.
If you do not meet the income or prescription drug coverage criteria, your income is below a set upper limit, 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.
Medicare Part D patients might be eligible, contact program for details. |
| Income at or below: |
Single |
|
400
% FPL |
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Couple |
|
400
% FPL |
| Federal Poverty Level Calculator |
 |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
Yes |
| US citizenship/residency specified:
|
Yes |
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APPLICATION |
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| Attachments
Required: |
None
|
Physician
License #
Required: |
State
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Prescriber
Signature
Allowed: |
Physician
PA
|
Application
may be
faxed: |
No |
Eligibility
determination
letter sent: |
Not Published
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| MEDICATION |
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| Receives: |
Medication
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| Shipped To: |
Either Provider and Patient
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| Quantity in
Shipment: |
90 days
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| Delivery Time: |
0-1 week
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| Re-application
Policy: |
New application every 12 months
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| Refill Policy: |
3 refills
Patient must contact program for refills |
| Other Information: |
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Last Updated: 11/22/2024
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Application Forms
& Instructions
The following documents
are provided in interactive PDF format, allowing you to type information
directly into the form.
 Form (English)
Form (Spanish)
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