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?
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RESOURCES FOR RENFLEXIS

RESOURCE
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Electronic Enrollment

The Merck Access Program 2020 Electronic Enrollment FormThis form can be signed and submitted electronically. Use this form only if the patient is in the office and you are able to complete this form together.
The Merck Access Program 2020 Electronic Health Care Provider Enrollment FormThis Health Care 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-renflexis.com/hcc.
Online Portal

Enrollment

The Merck Access Program 2019 Enrollment Form
The Merck Access Program 2020 Enrollment Form Use this form for patients choosing to re-enroll.
Potential Independent Foundation Support

Coverage and reimbursement support

Biosimilars Reimbursement Flashcard
Prior Authorization Checklist
Sample Prior Authorization Letter
Appeal Checklist
Sample Appeal Letter

Coding and billing resources

Billing and Coding Card
Sample CMS-1500 Form
Sample UB-04 Form

Product support materials

RENFLEXISHCP.com

Product Information

Physician Prescribing Information
Medication Guide

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 health care professional.

HCPCS=Healthcare Common Procedure Coding Systems.


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