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
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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
