To get started, select a category above or call 877-709-4455 to speak with a representative, Monday through Friday, 8 AM to 8 PM ET
To get started, select a category above or call 877-709-4455 to speak with a representative, Monday through Friday, 8 AM to 8 PM ET
The Merck Co-pay Assistance Program for ZINPLAVA™ (bezlotoxumab) Injection 25 mg/mL ("Program Product")
US-MKB-00718 11/23
RESOURCES
RESOURCE
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Electronic Enrollment
The Merck Access Program Electronic Enrollment Form
This form can be signed and submitted electronically. Use the form only if the patient is in the office and you are able to complete the form together.
The Merck Access Program Electronic Healthcare Provider Enrollment Form
This Healthcare Provider form can be signed and submitted electronically. Please note that the patient must also submit the Electronic Patient Enrollment Form, which can be found at www.merckaccessprogram-zinplava.com/hcc
Enrollment
The Merck Access Program Enrollment Form
This form can be downloaded and printed, and requires an original signature.
Coding and Billing
Coverage and Reimbursement Support
Product Information
The information available here is compiled from sources believed to be accurate, but Merck makes no representation that it is accurate. This information is subject to change. Payer coding requirements may vary or change over time, so it is important to regularly check with each payer as to payer-specific requirements.
The information available here is not intended to be definitive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Merck and its agents make no warranties or guarantees, express or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs.
You are solely responsible for determining the appropriate codes and for any action you take in billing. Information about HCPCS codes is based on guidance issued by the Centers for Medicare & Medicaid Services applicable to Medicare Part B and may not apply to other public or private payers. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of a particular code and for information on additional codes. Diagnosis codes should be selected only by a healthcare professional.
The Merck Co-pay Assistance Program for ZINPLAVA™ (bezlotoxumab) Injection 25 mg/mL ("Program Product")
US-MKB-00718 11/23