Download the AccessCUBICIN Enrollment Form
Download the Co-pay Assistance Program Form
AccessCUBICIN is designed to help facilitate patient access to CUBICIN.
You and your patients can learn more about the AccessCUBICIN program by calling 844-282-4246 to speak with a live representative.
Co-pay Assistance Program for eligible, privately insured patients:
The Co-pay Assistance Program offers assistance to eligible patients who need help affording CUBICIN. Once enrolled, eligible, privately insured patients pay the first $35 of their co-pay per infusion. Maximum benefit is $1,000 per patient, prior to the expiration date of the Program. Co-pay assistance from the Co-pay Assistance Program is not insurance. Restrictions and Terms and Conditions apply.
Fax the completed enrollment form along with an Explanation of Benefits (EOB) from the patient’s private health insurance company to 888-567-1227.
To qualify, patients must:
- Be at least 18 years old
- Reside within the United States (including Puerto Rico)
- Have private health insurance that provides coverage for CUBICIN under a medical benefit program
- Be prescribed CUBICIN for an FDA-approved indication
- Meet all other Terms and Conditions of the program
The Co-pay Assistance Program is not valid for patients covered under a Government Program or Exchange Plan, as those terms are defined in the Terms and Conditions. The Co-pay Assistance Program is not valid for uninsured patients. Patients and health care professional must submit all required information. Please see enrollment form for details.
Merck Patient Assistance Program
Patients who do not have insurance may be eligible for free product from the Merck Patient Assistance Program if they meet certain financial and medical criteria.
For more information on the program's eligibility requirements, please visit Merck Helps™.
AccessCUBICIN will contact the patient's insurance provider to request coverage and benefits information about out-of-pocket costs for the patient. The program also will help answer questions about billing and coding information.
Call AccessCUBICIN at 844-282-4246.
For more information or for answers to specific questions, call AccessCUBICIN at:
Monday–Friday, 8:00 AM–8:00 PM ET
Saturday, 9:00 AM–1:00 PM ET
If you have trouble connecting to enroll your patient at the numbers above, please use alternate. Phone: 407-888-5304, Fax: 407-888-5305