The Merck Access Program for RENFLEXIS® (infliximab-abda)
Before prescribing RENFLEXIS, please read the accompanying Prescribing Information including the Boxed Warning about serious infections and malignancies. The Medication Guide also is available.

WELCOME TO

THE MERCK ACCESS PROGRAM

ARE YOU A US HEALTH CARE PROFESSIONAL?
YES
NO

ENROLL NOW

Please click on the links below to access The Merck Access Program forms that are applicable to you. If your patient is requesting a referral to the Merck Patient Assistance Program, be sure to include all information, including a prescription for RENFLEXIS. Please be sure all signatures are included prior to submitting forms to The Merck Access Program.

DOWNLOAD & PRINT

These forms can be downloaded and printed, and require an original signature.

2019 Enrollment Form

2020 Enrollment Form

Use this form for patients choosing to re-enroll.

NEW SIGN & SUBMIT ELECTRONICALLY

These forms can be signed and submitted electronically.

PATIENT IN OFFICE

2020 Electronic Enrollment Form

Use this form if the patient is in the office and you are able to complete the form together.

PATIENT NOT IN OFFICE

2020 Electronic Health Care Provider Enrollment Form

Use this form when the patient is not in the office to complete the form with you.

The patient must also submit the Electronic Patient Enrollment Form.

ACCESS THE PORTAL

Register here for the Merck Access Portal.

Online Portal


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