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Merck Vaccine Patient Assistance for Gardasil (HPV Vaccine)

Merck has created a Patient Assistance Program for the Gardasil vaccine because very limited public funding is available in the United States. This private and confidential program provides the vaccine free of charge to eligible adults, primarily the uninsured who, without assistance, could not afford the Gardasil vaccine.

Who May Qualify

You may be eligible for the program if all three of the following conditions apply:

  • You live in the U. S. and are between the ages of 19 and 26. You do not have to be a U.S. citizen.
  • You have no health insurance or your insurance does not cover vaccinations.
  • Your annual household income is less than:
    • $21,660 for individuals
    • $29,140 for couples
    • $44,100 for a family of four

      • If you do not meet these criteria, you may still qualify for the vaccine program if you have special circumstances of financial and medical hardship.

      Upper income limit for exceptions is:
    • $43,320 for individuals
    • $58,280 for couples
    • $88,200 for a family of four

How the Program Works

  1. To download a Gardasil Patient Assistance Application go to Downloadable Forms or pick one up at the University Health Center Information Desk. Complete and sign page one of the application.
  2. Bring the completed application to UHC´s Information Desk. Merck must approve your application before you can get the vaccine through their program.
  3. Annette Hraban (Patient Assistance Program Coordinator, Telephone: 472-7479) will fax your application to Merck. If you have any type of insurance, Merck will fax back an appeal form. You will need to come back to UHC and sign this appeal. After the appeal form has been faxed, Annette will notify you of your approval status. If you do not hear from us in 10 days, please call 472-7479 to check on the status of your application. After you are approved, call 472-5000 to schedule an appointment for the vaccine. There will be a $6.00 injection fee for each dose.
  4. The HPV vaccine is given in three doses over several months. A new application for each dose is required. Please submit this application 2-3 weeks BEFORE your next injection is due.
  5. If you have any questions about the Merck program, you may call 1-800-727-5400, 8am - 8 pm ET, Monday - Friday.