ONTRUZANT® (trastuzumab-dttb) Logo

Please read the Prescribing Information for ONTRUZANT, including the
information about heart problems, infusion reactions (lung problems),
and harm to an unborn baby, and discuss it with your doctor.


SUPPORT RESOURCES

RESOURCE
Electronic Enrollment

The Merck Access Program 2021 Electronic Patient Enrollment Form

This patient form can be signed and submitted electronically. Please note that your health care provider must also submit the Health Care Provider Enrollment Form.

Enrollment

The Merck Access Program 2020 Enrollment Form

The Merck Access Program 2021 Enrollment Form

Use this form to re-enroll in The Merck Access Program

The Merck Access Program Sample Enrollment Form

Representative's Form

Potential Independent Foundation Support

Patient Support Materials

ONTRUZANT.com

Product Information

Physician Prescribing Information



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THE MERCK ACCESS PROGRAM

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