The Patient Rebate Program for GARDASIL: For Health Care Professionals

Questions About Patient Eligibility

Is there an age requirement in order to be eligible for the rebate?
Are male patients eligible for the rebate?
What type of insurance does my patient need to be eligible for the rebate?
Is my patient eligible for the rebate if he/she has no health insurance?
Why isn't the Patient Rebate Program available to my uninsured patients?
Is my patient eligible for the rebate if he/she has government-funded health insurance (such as Medicaid, Medicare, Veterans Benefits, TRICARE, etc)?
Does my patient have to be a resident of the United States to be eligible for the rebate?
Why is the rebate not available for patients or persons responsible for the out-of-pocket cost of the dose of GARDASIL who are residents of Colorado or Massachusetts?
Are residents of Puerto Rico or the United States territories eligible for the rebate?
Are doses of GARDASIL administered outside of the United States eligible for the rebate?
If a person other than my patient is responsible for the out-of-pocket cost for GARDASIL, does this person have to be a resident of the United States to be eligible for the rebate?
Are my patients between the ages of 9 and 18 eligible for the rebate?
Why aren't my patients between the ages of 9 and 18 eligible for the rebate?
If I learn through the Merck Vaccine Reimbursement Support Center (MVRSC) that my patient's out-of-pocket cost is over $30, is my patient still eligible for a rebate?
If my patient receives his/her first or second dose of GARDASIL before his/her 27th birthday, will he/she be eligible for a rebate on doses administered after he/she turns 27?
In my practice, I have a parent with more than one child. Is each child eligible for the rebate?

Questions About the Administration of the Dose of GARDASIL

Questions About the Rebate Request Form

Questions About the Rebate

Questions about the Explanation of Benefits (EOB) Document

Questions About the Terms and Conditions

Questions About the Status of the Rebate

Questions About the Third-Party Administrator

General Questions About the Program

Is there an age requirement in order to be eligible for the rebate?

Your patient must be between the ages of 19 and 26 when the dose of GARDASIL is administered to be eligible to receive the rebate.

Are male patients eligible for the rebate?

Yes. Male patients between the ages of 19 and 26 when the dose of GARDASIL is administered are eligible to receive the rebate. The dose must be administered between January 1, 2010, and December 31, 2010, and all other Terms and Conditions must be met.

Male patients must submit the correct rebate request form (a red form) that indicates that male patients are eligible to receive the rebate.

Male patients are not eligible for the rebate if the submission includes a rebate request form that indicates only female patients are eligible to receive the rebate (a blue form).

What type of insurance does my patient need to be eligible for the rebate?

Your patient must have private health insurance at the time the dose of GARDASIL is administered to be eligible for the rebate.

Your patient is not eligible for the rebate if he/she is covered under a government-funded program such as Medicaid, Medicare, Veterans Benefits, TRICARE, or any other state or federal program.

Is my patient eligible for the rebate if he/she has no health insurance?

Your patient is not eligible for the rebate if he/she is uninsured. He/She must have private health insurance at the time the dose of GARDASIL is administered to be eligible for the rebate.

Why isn't the Patient Rebate Program available to my uninsured patients?

The Patient Rebate Program for GARDASIL is for patients with private health insurance.

GARDASIL is available through the Merck Vaccine Patient Assistance Program for qualified patients.

You can learn more about the Merck Vaccine Patient Assistance Program at merckhelps.com or by calling 1-800-239-3881, 8:00 AM-8:00 PM ET, Monday through Friday, where a live Patient Assistance Program specialist will be available to assist you.

Is my patient eligible for the rebate if he/she has government-funded health insurance (such as Medicaid, Medicare, Veterans Benefits, TRICARE, etc)?

Your patient is not eligible for the rebate if he/she is covered under a government-funded insurance program such as Medicaid, Medicare, Veterans Benefits, TRICARE, or any other state or federal program.

Does my patient have to be a resident of the United States to be eligible for the rebate?

Yes, your patient must be a resident of the United States and the dose of GARDASIL must be administered in the United States to be eligible for the rebate.

However, he/she must not be a resident of Colorado or Massachusetts.

Why is the rebate not available for patients or persons responsible for the out-of-pocket cost of the dose of GARDASIL who are residents of Colorado or Massachusetts?

The Patient Rebate Program is not available to residents of Colorado and Massachusetts because of state restrictions.

Are residents of Puerto Rico or the United States territories eligible for the rebate?

No, if your patient is a resident of Puerto Rico or the United States territories, he/she is not eligible for the rebate. Your patient must be a resident of the United States and the dose of GARDASIL must be administered in the United States to be eligible for the rebate. If a person other than the patient is responsible for the out-of-pocket cost for the dose, this person must be a resident of the United States to be eligible for the rebate.

Are doses of GARDASIL administered outside of the United States eligible for the rebate?

No. Your patient must be a resident of the United States and the dose of GARDASIL must be administered in the United States to be eligible for the rebate.

If a person other than my patient is responsible for the out-of-pocket cost for GARDASIL, does this person have to be a resident of the United States to be eligible for the rebate?

Yes, both your patient and the person responsible for the out-of-pocket cost for the dose of GARDASIL must be residents of the United States and the dose must be administered in the United States to be eligible for the rebate.

Are my patients between the ages of 9 and 18 eligible for the rebate?

No, children between the ages of 9 and 18 are not eligible for the rebate. Only patients who are between the ages of 19 and 26 when the dose of GARDASIL is administered are eligible to receive the rebate.

Why aren't my patients between the ages of 9 and 18 eligible for the rebate?

Merck's understanding is that the issue of potential out-of-pocket costs is a greater concern for patients over age 18.

If I learn through the Merck Vaccine Reimbursement Support Center (MVRSC) that my patient's out-of-pocket cost is over $30, is my patient still eligible for a rebate?

Yes, provided that all other eligibility requirements and Terms and Conditions of the Program are met.

If my patient receives his/her first or second dose of GARDASIL before his/her 27th birthday, will he/she be eligible for a rebate on doses administered after he/she turns 27?

No, your patient must be between the ages of 19 and 26 when the dose of GARDASIL is administered (as consistent with the Prescribing Information) to be eligible to receive the rebate.

In my practice, I have a parent with more than one child. Is each child eligible for the rebate?

As long as each child is between the ages of 19 and 26 when the dose of GARDASIL is administered and all other Terms and Conditions are met, he or she is eligible to receive the rebate.

An original completed rebate request form and a copy of the patient's Explanation of Benefits (EOB) document (that indicates the out-of-pocket cost of the dose of GARDASIL to be more than $30) must be submitted for each child.

When does the dose of GARDASIL have to be administered to be eligible for the rebate?

For female patients between the ages of 19 and 26, the dose of GARDASIL must be administered between April 1, 2009, and December 31, 2010, to be eligible for the rebate. Doses administered before April 1, 2009, and after December 31, 2010, are not eligible.

For male patients between the ages of 19 and 26, the dose of GARDASIL must be administered between January 1, 2010, and December 31, 2010, to be eligible for the rebate. Doses administered before January 1, 2010, and after December 31, 2010, are not eligible.

Does the dose of GARDASIL have to be administered in the United States to be eligible for the rebate?

Yes, the dose of GARDASIL must be administered in the United States to be eligible for the rebate.

Who should fill out and sign the "Patient Certification" section of the rebate request form?

The "Patient Certification" section of the rebate request form is filled out and signed by the patient who received the dose of GARDASIL on the date indicated in the "Health Care Professional Certification" section of the form.

Does my patient have to provide all of the information requested in the "Patient Certification" section of the rebate request form?

Your patient must provide all information requested on the rebate request form and must sign and date the "Patient Certification."

Rebate request forms that are not filled out completely or are modified will not be eligible for a rebate.

We need his/her birth date to verify that he/she was between the ages of 19 and 26 when the dose of GARDASIL was administered.

We need his/her phone number in case we need to contact him/her to verify any of his/her information as we process the request for a rebate.

We need his/her gender to verify that the dose of GARDASIL was administered during the eligible time period.

Who should fill out and sign the "Primary Insured Certification" section of the rebate request form?

The "Primary Insured Certification" section of the rebate request form is filled out and signed by the person responsible for the out-of-pocket cost for the dose of GARDASIL administered to the patient listed on the form.

This person could be the patient, if the private health insurance is in the patient's name and the patient is personally responsible for the out-of-pocket cost, or someone else (such as a parent, legal guardian, or spouse) if the private health insurance is not in the patient's name.

Does the person responsible for the out-of-pocket cost for the dose of GARDASIL have to provide all of the information requested in the "Primary Insured Certification" section of the rebate request form?

The person responsible for the out-of-pocket cost for the dose of GARDASIL must provide all information requested on the rebate request form and must sign and date the "Primary Insured Certification."

Rebate request forms that are not filled out completely or are modified will not be eligible for a rebate.

We need the phone number of the person responsible for the out-of-pocket cost in case we need to contact him/her to verify any of the health insurance information as we process the request for a rebate.

Can I delete something from the Terms and Conditions or the Certification(s) on the rebate request form?

Rebate request forms that are modified or have sections of the Terms and Conditions or Certifications blacked out will not be eligible for a rebate.

Can my patient delete something from the Terms and Conditions or the Certification(s) on the rebate request form?

Rebate request forms that are modified or have sections of the Terms and Conditions or Certifications blacked out will not be eligible for a rebate.

Who should fill out and sign the "Health Care Professional Certification" section of the rebate request form?

While either a licensed doctor or health care professional or a qualified employee acting at his or her direction (such as a nurse) may administer the dose of GARDASIL, the "Health Care Professional Certification" section of the rebate request form can only be signed by the licensed doctor or health care professional (such as a nurse practitioner or physician assistant).

This section cannot be signed by a registered nurse.

This section cannot be filled out by the patient or the person responsible for the out-of-pocket cost for the dose of GARDASIL.

My patient just called to tell me that I forgot to sign/date/complete the "Health Care Professional Certification" section of the rebate request form. Can my patient complete this section on my behalf?

No, your patient or the person responsible for the out-of-pocket cost for the dose of GARDASIL cannot complete the "Health Care Professional Certification" section of the rebate request form on your behalf.

While either a licensed doctor or health care professional or a qualified employee acting at his or her direction (such as a nurse) may administer the dose of GARDASIL, the "Health Care Professional Certification" section can only be signed by the licensed doctor or health care professional (such as a nurse practitioner or physician assistant).

This section cannot be signed by a registered nurse.

If this section is incomplete or missing a signature, your patient or the person responsible for the out-of-pocket cost for the dose of GARDASIL must bring the rebate request form back to you to have this section completed in order to be eligible for the rebate.

May I use a stamp instead of an original signature on the rebate request form?

The licensed doctor or health care professional who administered the dose of GARDASIL must sign the "Health Care Professional Certification" section of the rebate request form with an original signature. Stamped signatures are not accepted.

If you used a stamp signature for this section, your patient or the person responsible for the out-of-pocket cost for GARDASIL must bring the rebate request form back to you to have this section signed with an original signature in order to be eligible for the rebate.

Where does my patient mail the rebate request form?

The original completed rebate request form and a copy of the patient's Explanation of Benefits (EOB) document your patient received from his/her private health insurance company (that indicates the out-of-pocket cost of GARDASIL to be more than $30) is mailed to:

Patient Rebate Program for GARDASIL
PO Box 748
Horsham, PA 19044

As a reminder, rebate request forms postmarked more than 90 days after the date of administration of the dose of GARDASIL are not eligible for the rebate.

How soon must my patient mail the rebate request form?

The original completed rebate request form and a copy of the patient's Explanation of Benefits (EOB) document he/she received from his/her private health insurance company (that indicates the out-of-pocket cost of the dose of GARDASIL to be more than $30) must be postmarked within 90 days after the date of administration of the dose to be eligible for the rebate.

Rebate request forms postmarked more than 90 days after the date of administration of the dose of GARDASIL are not eligible for the rebate.

Do you accept photocopies of the rebate request form for processing?

To be eligible for the rebate, your patient must submit an original rebate request form and a copy of the patient's Explanation of Benefits (EOB) document he/she received from his/her private health insurance company (that indicates the out-of-pocket cost of GARDASIL to be more than $30).

Photocopies of the rebate request form are not accepted. However, photocopies of the EOB are accepted.

My patient lost the rebate request form that I gave him/her. How can he/she get another one?

If your patient misplaced the rebate request form, a new form must be obtained from the doctor or health care professional who administered the dose of GARDASIL.

As a reminder, rebate request forms postmarked more than 90 days after the date of administration of the dose of GARDASIL are not eligible for the rebate.

How can our office get rebate request forms?

You can call 1-800-GARDASIL to learn more about the Program.

How soon can our office get rebate request forms?

Rebate request forms will be either hand-delivered by your Merck Sales Representative or shipped directly to your office within 3 to 4 weeks.

I do not feel comfortable providing my state license number in the "Health Care Professional Certification" section of the rebate request form. Why is this information needed to process the rebate?

To ensure that the "Health Care Professional Certification" section of the rebate request form is signed by the licensed doctor or health care professional (such as a nurse practitioner or physician assistant) and not signed by a registered nurse, the patient, or the person responsible for the out-of-pocket cost for the dose of GARDASIL, the state license number is requested.

All information provided on the rebate request form will be held in strict confidence by Merck and the third-party administrator.

Can my Merck Sales Representative assist me or my patient in completing or mailing a rebate request form?

No, Merck Sales Representatives may not assist you or your patients in completing or mailing rebate request forms. If you have questions, please call 1-800-GARDASIL to learn more about the Program.

I have rebate request forms that indicate only female patients are eligible for the rebate. Can I give this form to my male patients?

Male patients must submit the correct rebate request form. It is a red form and indicates that male patients are eligible to receive the rebate.

Male patients are not eligible for the rebate if the submission includes a rebate request form that indicates only female patients are eligible to receive the rebate (a blue form).

You can call 1-800-GARDASIL to obtain the correct rebate request forms.

How soon will the person responsible for the out-of-pocket cost for GARDASIL receive the check after the rebate request form is mailed?

It typically takes 6 to 8 weeks to process the rebate.

What is the maximum rebate amount per dose of GARDASIL?

The rebate is limited to the amount the private health insurance company indicates on the patient's Explanation of Benefits (EOB) document that the patient or the person responsible for the out-of-pocket cost is obligated to pay for the dose of GARDASIL minus $30, up to a maximum of $130. The maximum rebate for each dose is $130, regardless of the amount the patient or the person responsible for the out-of-pocket cost for the dose actually paid or is obligated to pay.

For which costs is the rebate valid?

The rebate is valid for the out-of-pocket cost for the dose of GARDASIL only. The rebate is not valid for any other products or other out-of-pocket costs (for example, office visit charges, office visit co-payments, or vaccine administration charges) even if such costs are associated with the administration of the dose of GARDASIL.

Does the rebate cover the cost of the office visit or the cost to administer the dose of GARDASIL?

No, the rebate is not valid for any other products or other out-of-pocket costs (for example, office visit charges, office visit co-payments, or vaccine administration charges) even if such costs are associated with the administration of the dose of GARDASIL.

The rebate is valid for the out-of-pocket cost for the dose of GARDASIL only.

Why doesn't the Patient Rebate Program cover the cost of the office visit or the cost to administer the dose of GARDASIL?

The Patient Rebate Program for GARDASIL is offered by Merck, the manufacturer of GARDASIL.

Can I request the rebate on my patient's behalf?

No, you may not request the rebate on your patient's behalf. Only the patient or the person responsible for the out-of-pocket cost for the dose of GARDASIL may request the rebate.

Can the rebate check be mailed directly to me?

No, you may not receive the rebate directly from Merck. Only the patient or the person responsible for the out-of-pocket cost for the dose of GARDASIL may request and receive the rebate.

Your patient or the person responsible for the out-of-pocket cost remains obligated to pay you for the dose of GARDASIL.

Can my patient's parent/legal guardian request the rebate on his/her behalf?

If your patient's parent/legal guardian is responsible for the out-of-pocket cost for the dose of GARDASIL, he/she may request and receive the rebate. Your patient's parent/legal guardian will fill out, sign, and date the "Primary Insured Certification" section of the rebate request form.

Your patient will still need to fill out, sign, and date the "Patient Certification" section of the rebate request form.

The rebate check will be mailed directly to the person responsible for the out-of-pocket cost (in this case, your patient's parent/legal guardian).

My patient's parent/legal guardian is responsible for the out-of-pocket cost for the dose of GARDASIL. Can the rebate check be mailed directly to my patient?

No, the rebate check will be mailed directly to the person responsible for the out-of-pocket cost for the dose of GARDASIL (in this case, your patient's parent/legal guardian) as listed in the "Primary Insured Certification" section of the rebate request form.

How much can my patient expect to receive as a rebate?

If the patient's EOB indicated an out-of-pocket amount of $30 or less for the dose of GARDASIL, your patient will not be eligible for a rebate and should not submit a rebate request form.

If the patient's EOB indicated an out-of-pocket amount of more than $30 but less than $160, the rebate would be that amount less $30. For example, if the patient's EOB listed an out-of-pocket cost for the dose of GARDASIL as $75, the rebate would be $45.

If the patient's EOB indicated an out-of-pocket amount equal to or greater than $160, the rebate would be $130, the maximum amount. For example, if the patient's EOB listed an out-of-pocket cost for the dose of GARDASIL as $175, the rebate would be $130.

Can the rebate check be sent to a Post Office Box?

Yes, the rebate check can be sent to a Post Office Box.

By what form of mail or delivery service will the rebate check be delivered?

The rebate check will be mailed via United States Postal Service.

Will someone need to sign for the delivery of the rebate check?

No, no one will need to sign for the delivery of the rebate check. The rebate check will be mailed via United States Postal Service.

Does my patient need to report receipt of the rebate to his/her private health insurance company?

Your patient may be responsible for reporting receipt of the rebate to his/her private health insurance company or any other third party that pays for or reimburses any part of the costs associated with the administration of the dose of GARDASIL for which he/she is seeking this rebate.

Your patient should check with his/her private health insurance company to learn if he/she must report receipt of the rebate.

Does the rebate cover the deductible my patient has with his/her private insurance company?

If the patient's Explanation of Benefits (EOB) document indicates that there is a deductible, and that the out-of-pocket cost for the dose of GARDASIL is part of this deductible, then this amount is eligible for the rebate. The rebate is limited to the amount the private health insurance company indicates on the patient's EOB that the patient or the person responsible for the out-of-pocket cost is obligated to pay for the dose minus $30, up to a maximum of $130. The maximum rebate for each dose is $130, regardless of the amount the patient or the person responsible for the out-of-pocket cost for the dose actually paid or is obligated to pay. All other Terms and Conditions must still be met.

What is an Explanation of Benefits document or EOB?

The Explanation of Benefits document, often called an EOB, is sent by the private health insurance company after your patient receives medical care. When your patient receives the EOB for the day that the dose of GARDASIL was administered, it should provide certain details, such as the negotiated contract rate for GARDASIL as well as the out-of-pocket cost the patient owes for the dose.

When should my patient receive the Explanation of Benefits (EOB) document?

The length of time a person has to wait for an Explanation of Benefits (EOB) document varies by private health insurance company.

Many private health insurance companies mail the patient's EOB; others provide it online. If your patient's private health insurance company does not provide an EOB unless he/she requests it, or does not provide it within 90 days of the date of the medical service, he/she will need to contact the company to receive one.

For example, if your patient's private health insurance company provides an EOB quarterly, he/she may need to contact the company to receive the patient's EOB sooner so that he/she can send in the rebate request form within 90 days of the date of administration of the dose of GARDASIL.

A copy of the patient's EOB must accompany the original completed rebate request form to be eligible for the rebate. As a reminder, rebate request forms postmarked more than 90 days after the date of administration of the dose of GARDASIL are not eligible for the rebate.

My patient never received an Explanation of Benefits (EOB) document for the dose of GARDASIL that was administered. Can he/she submit the rebate request form without it?

A copy of the patient's Explanation of Benefits (EOB) document must accompany the original completed rebate request form to be eligible for the rebate. The patient's EOB is needed to review the out-of-pocket cost for the dose of GARDASIL, as set by the private health insurance company, to determine the amount of the rebate.

If your patient's private health insurance company did not provide an EOB, he/she will need to contact the company to receive one.

As a reminder, rebate request forms postmarked more than 90 days after the date of administration of the dose of GARDASIL are not eligible for the rebate.

Can my patient submit my bill with the rebate form instead of the Explanation of Benefits (EOB) document?

A copy of the patient's Explanation of Benefits (EOB) document must accompany the original completed rebate request form to be eligible for the Rebate. The patient's EOB is needed to review the out-of-pocket cost for the dose of GARDASIL, as set by the private health insurance company, to determine the rebate amount.

A bill from your office is not a valid form of proof of the out-of-pocket cost for the dose of GARDASIL, as set by the private health insurance company.

If your patient's private health insurance company did not provide an EOB, your patient will need to contact the company to receive one.

As a reminder, rebate request forms postmarked more than 90 days after the date of administration of the dose of GARDASIL are not eligible for the rebate.

Do you accept photocopies of the Explanation of Benefits (EOB) document for processing?

Photocopies of the patient's Explanation of Benefits (EOB) document are accepted.

However, photocopies of the rebate request form are not accepted.

My patient's Explanation of Benefits (EOB) document contains additional patient information not associated with the administration of the dose of GARDASIL. Is that OK?

The patient's Explanation of Benefits (EOB) document that is submitted with the rebate request form should contain only the patient's own health information. It is acceptable to black out any additional patient information on the patient's EOB that is not associated with the cost of the dose of GARDASIL.

All patient information contained in the patient's EOB, whether associated with the administration of GARDASIL or not, will be held in strict confidence by Merck and the third-party administrator.

My patient's Explanation of Benefits (EOB) document indicates that the out-of-pocket cost for the dose of GARDASIL is equal to or less than $30. Is my patient eligible for a rebate?

In order to be eligible for a rebate, the out-of-pocket cost for the dose of GARDASIL must be greater than $30.

An out-of-pocket cost equal to or less than $30 is not eligible for a rebate.

My patient's Explanation of Benefits (EOB) document does not distinguish between the out-of-pocket cost for the dose of GARDASIL itself and the costs associated with the administration of the dose. How will the rebate be calculated?

If it appears that the cost of the dose of GARDASIL reflected on the patient's Explanation of Benefits (EOB) document has been bundled with the administration cost, the third-party administrator may initiate contact with the private health insurance company in an attempt to determine the out-of-pocket cost of GARDASIL only.

However, if the third-party administrator is unable to distinguish between the out-of-pocket cost for the dose of GARDASIL itself and the costs associated with the administration of the dose, the total amount reflected on the patient's EOB will be used to calculate the rebate.

The rebate is limited to the amount the private health insurance company indicates on the patient's EOB that the patient or the person responsible for the out-of-pocket cost is obligated to pay for the dose of GARDASIL minus $30, up to a maximum of $130. The maximum rebate for each dose is $130, regardless of the amount the patient or the person responsible for the out-of-pocket cost for the dose actually paid or is obligated to pay.

How can my patient be sure he/she is sending in the right Explanation of Benefits (EOB) document?

The private health insurance company determines the format of the Explanation of Benefits (EOB) document. Your patient will want to be certain that the date of service listed on the patient's EOB matches the date of administration of the dose of GARDASIL in the "Health Care Professional Certification" section of the rebate request form and that the patient's EOB contains a charge for the dose .

If your patient is uncertain if he/she has the right document, he/she should contact his/her health insurance company to confirm that the patient's EOB is the correct document to be included with the rebate request form.

My patient's Explanation of Benefits (EOB) document contains confidential information not associated with the administration of the dose of GARDASIL. Will this information remain confidential?

If other medical services were provided the day the dose of GARDASIL was administered to your patient, the patient's Explanation of Benefits (EOB) document could contain information that is not associated with the cost of the dose.

Because we need only the information associated with the cost of the dose of GARDASIL to process the rebate, it is acceptable for your patient to black out any additional information on the patient's EOB that is associated with other medical services.

All patient information contained in the patient's EOB, whether associated with the administration of GARDASIL or not, will be held in strict confidence by Merck and the third-party administrator.

I do not stock GARDASIL. I gave my patient a prescription to fill at the pharmacy and he/she brought the dose that he/she purchased back to me for administration. Can he/she submit the pharmacy receipt with the rebate request form instead of the Explanation of Benefits (EOB) document?

A bill from your patient's pharmacy is not a valid form of proof of the out-of-pocket cost for the dose of GARDASIL, as set by the private health insurance company.

If you did not file a claim with your patient's private health insurance company on his/her behalf, your patient will need to contact the company to file the claim in order to obtain an EOB.

As a reminder, rebate request forms postmarked more than 90 days after the date of administration of the dose of GARDASIL are not eligible for the rebate.

My patient has private health insurance; however, I am not going to file a claim for the dose of GARDASIL with his/her insurance company. Can my patient submit the receipt I provide him/her with the rebate request form since he/she will not receive an Explanation of Benefits (EOB) document?

A receipt from your office is not a valid form of proof of the out-of-pocket cost for the dose of GARDASIL, as set by the private health insurance company.

If you did not file a claim with your patient's private health insurance company, your patient will need to contact the company to file the claim in order to obtain an EOB.

As a reminder, rebate request forms postmarked more than 90 days after the date of administration of the dose of GARDASIL are not eligible for the rebate.

My patient has private health insurance; however, I did not file a claim for the dose of GARDASIL with his/her insurance company. In order to obtain an Explanation of Benefits (EOB) document, he/she filed the claim. The EOB he/she received from his/her private health insurance indicates that his/her claim is denied. Is he/she eligible for the rebate?

Whether your patient is eligible for the rebate will depend on the reason the claim was denied and whether all other Terms and Conditions of the Program are met. If your patient's EOB indicates that he/she has private health insurance and is responsible for the out-of-pocket cost for the dose of GARDASIL in an amount greater than $30, and all other Terms and Conditions are met, he/she would be eligible for the rebate.

An out-of-pocket cost equal to or less than $30 is not eligible for a rebate.

The doctor or health care professional that my patient's private health insurance company listed on the Explanation of Benefits (EOB) document is not the doctor or health care professional who administered the dose of GARDASIL (as indicated on the rebate request form). Is that OK?

Yes, as long as the licensed doctor or health care professional who administered the dose of GARDASIL signed the "Health Care Professional Certification" section of the rebate request form with an original signature (stamped signatures are not accepted) and the date of administration of the dose of GARDASIL on the patient's Explanation of Benefits (EOB) document matches the date of administration on the rebate request form.

Based on how different private health insurance companies contract with doctor's offices, it is possible that the patient's EOB will list a doctor or health care professional different from the one who actually administered the dose of GARDASIL.

Is my patient still obligated to pay my bill for the dose of GARDASIL that I administered?

Yes, your patient is obligated to pay all costs incurred with the administration of the dose of GARDASIL. Your patient must certify on the rebate request form that he/she has paid or will pay you for all out-of-pocket costs associated with the dose of GARDASIL.

The rebate is intended for the person responsible for the out-of-pocket cost for the dose of GARDASIL only. The rebate is not intended for the doctor or health care professional.

How many times can my patient submit for a rebate?

Your patient is limited to three (3) rebate request submissions (one for each dose of GARDASIL, provided the eligibility criteria and Terms and Conditions are met for each dose).

Your patient needs to submit a new rebate request form and Explanation of Benefits (EOB) document each time a dose of GARDASIL is administered.

It is important to note that your patient's rebate on each dose of GARDASIL may vary. This could occur if a change in his/her health insurance plan design occurs in the middle of the vaccine series. Or he/she may have met his/her deductible or preventive care cap in the middle of the vaccine series.

How can my patient check on the status of his/her rebate?

Your patient can call 1-800-GARDASIL for information on the status of his/her rebate.

How will my patient learn if he/she is not eligible for a rebate?

If your patient mailed in a rebate request form and we determine he/she is not eligible for a rebate, he/she will receive a letter indicating why.

My patient has questions about a letter he/she received that requests additional information in order to process the rebate. To whom can he/she speak?

Your patient can call 1-800-GARDASIL.

My patient has questions about a letter he/she received that indicates his/her request was not eligible for the rebate. To whom can he/she speak?

Your patient can call 1-800-GARDASIL.

Who is the third-party administrator processing the rebate?

Telerx is the third-party administrator processing the Patient Rebate Program for GARDASIL.

Telerx is a separate wholly owned subsidiary of Merck.

Why would the third-party administrator need to contact my patient, his/her private health insurance company, and/or me?

The third-party administrator may need to contact your patient, his/her private health insurance company, and/or you in order to process the rebate.

For example, based on the patient's Explanation of Benefits (EOB) document, it may be unclear what the out-of-pocket cost for the dose of GARDASIL is. The third-party administrator would contact your patient's private health insurance company to help validate this information.

Why is Merck offering the Patient Rebate Program for GARDASIL?

Many young adult men and women may be concerned about the out-of-pocket cost of GARDASIL and delay beginning the vaccination series.

The Patient Rebate Program for GARDASIL was created to help. By telling your eligible privately insured patients about the Program:

You can help ensure your patients' out-of-pocket cost is more predictable.
Your patients won't miss an opportunity to get vaccinated while they are in the office.
You'll be able to keep the discussion focused on your explicit recommendations instead of the out-of-pocket costs.

How does the Patient Rebate Program for GARDASIL work?

The Patient Rebate Program for GARDASIL provides your eligible privately insured female patients with a rebate for the out-of-pocket cost over $30 for each dose of GARDASIL administered between April 1, 2009, and December 31, 2010.

The Program provides your eligible privately insured male patients with a rebate for the out-of-pocket cost over $30 for each dose of GARDASIL administered between January 1, 2010, and December 31, 2010.

Provide your eligible privately insured patient with a rebate request form at the time of vaccination. Before handing out these forms to your patients, become familiar with the Terms and Conditions and the "Health Care Professional Certification" section. Be sure the form includes the date of vaccination and your office information, along with your original signature (stamps are not accepted).

Your patient completes the "Patient Certification" section of the rebate request form. The patient or the person responsible for the out-of-pocket cost for GARDASIL (such as his/her parent, legal guardian, or spouse) completes the "Primary Insured Certification" section of the form.

Your patient or the person responsible for the out-of-pocket cost receives an Explanation of Benefits (EOB) document from the private health insurance company.

The original rebate request form and a copy of the patient's EOB are mailed to the address provided. Your patient needs to submit a new rebate request form and EOB each time he/she receives a dose of GARDASIL.

If eligibility requirements are met, the rebate check is mailed to the person responsible for the out-of-pocket cost in 6 to 8 weeks after each submission.

Please review the Terms and Conditions on the rebate request form or on gardasilrebate.com.

How long will the Patient Rebate Program for GARDASIL be available?

For female patients, the Patient Rebate Program for GARDASIL is available for doses of GARDASIL administered between April 1, 2009, and December 31, 2010. Doses administered before April 1, 2009, or after December 31, 2010, are not eligible.

For male patients, the Program is available for doses of GARDASIL administered between January 1, 2010, and December 31, 2010. Doses administered before January 1, 2010, or after December 31, 2010, are not eligible.

Merck reserves the right to rescind, cancel, or amend this offer at any time without notice.

Is this Program available for other Merck vaccines?

No, the Patient Rebate Program is not available for other Merck vaccines. It is available for GARDASIL only.

Is this Program an extension of the Merck Patient Assistance Program?

No, the Patient Rebate Program for GARDASIL is not an extension of the Merck Patient Assistance Program.

How is this Program different from the Merck Patient Assistance Program?

The Merck Patient Assistance Program provides access to vaccines to uninsured patients who are unable to afford vaccines.

The Patient Rebate Program for GARDASIL provides a partial rebate to eligible privately insured female patients between the ages of 19 and 26 for doses of GARDASIL administered between April 1, 2009, and December 31, 2010.

The Program provides a partial rebate to eligible privately insured male patients between the ages of 19 and 26 for doses of GARDASIL administered between January 1, 2010, and December 31, 2010.

Is this Program an extension of the Dose Replacement Program for GARDASIL?

No, the Patient Rebate Program for GARDASIL is not an extension of the Dose Replacement Program for GARDASIL.

How is this Program different from the Dose Replacement Program for GARDASIL?

The Patient Rebate Program for GARDASIL provides a partial rebate directly to your eligible privately insured patient or the person responsible for the out-of-pocket cost for the dose of GARDASIL administered to the patient.

The Dose Replacement Program for GARDASIL was designed to help address your reimbursement concerns for privately insured patients. Through that Program, offices that enroll are eligible to receive a limited number of replacement doses of GARDASIL when a dose is administered to a privately insured patient and you later learn that the patient's health insurance company provides no reimbursement.

For more information on the Dose Replacement Program for GARDASIL, visit drp4gardasil.com..

Can both my patient receive a rebate through the Patient Rebate Program for GARDASIL and I receive a replacement dose through the Dose Replacement Program for GARDASIL for the same dose that was administered to my patient?

No. If your patient receives a rebate through the Patient Rebate Program for GARDASIL, you cannot seek a replacement dose of GARDASIL for that same dose through the Dose Replacement Program for GARDASIL.

Likewise, if you receive a replacement dose of GARDASIL through the Dose Replacement Program for GARDASIL, your patient cannot seek a rebate for that same dose through the Patient Rebate Program for GARDASIL.

What is the CPT^a code for GARDASIL?

The CPT code for GARDASIL is 90649.

INDICATION

GARDASIL is a vaccine indicated in girls and women 9 through 26 years of age for the prevention of cervical, vulvar, and vaginal cancers; precancerous or dysplastic lesions; and genital warts caused by human papillomavirus (HPV) Types 6, 11, 16, and 18.

GARDASIL is indicated in boys and men 9 through 26 years of age for the prevention of genital warts caused by HPV Types 6 and 11.

GARDASIL does not eliminate the necessity for women to continue to undergo recommended cervical cancer screening.

GARDASIL has not been demonstrated to provide protection against diseases from vaccine and non-vaccine HPV types to which a person has previously been exposed through sexual activity.

GARDASIL is not intended to be used for treatment of active external genital lesions; cervical, vulvar, and vaginal cancers; cervical intraepithelial neoplasia (CIN), vulvar intraepithelial neoplasia (VIN), or vaginal intraepithelial neoplasia (VaIN).

GARDASIL has not been demonstrated to protect against diseases due to HPV types not contained in the vaccine.

Not all vulvar and vaginal cancers are caused by HPV, and GARDASIL protects only against those vulvar and vaginal cancers caused by HPV Types 16 and 18.

GARDASIL is contraindicated in individuals with hypersensitivity, including severe allergic reactions to yeast, or after a previous dose of GARDASIL.

Because vaccinees may develop syncope, sometimes resulting in falling with injury, observation for 15 minutes after administration is recommended. Syncope, sometimes associated with tonic-clonic movements and other seizure-like activity, has been reported following vaccination with GARDASIL. When syncope is associated with tonic-clonic movements, the activity is usually transient and typically responds to restoring cerebral perfusion.

GARDASIL is not recommended for use in pregnant women.

The most common adverse reaction was headache. Common adverse reactions that were observed among recipients of GARDASIL at a frequency of at least 1.0% and greater than placebo were fever, nausea, dizziness; and injection-site pain, swelling, erythema, pruritus, and bruising.

DOSAGE AND ADMINISTRATION

GARDASIL should be administered in 3 separate intramuscular injections in the deltoid region of the upper arm or in the higher anterolateral area of the thigh over a 6-month period with the first dose at an elected date, the second dose 2 months after the first dose, and the third dose 6 months after the first dose.

Before administering GARDASIL, please read the Prescribing Information and Patient Product Information.