| Family Size | 100% | 133% | 150% | 200% | 250% | 300% |
| 1 | $10,830 | $14,404 | $16,245 | $21,660 | $27,075 | $32,490 |
| 2 | $14,570 | $19,378 | $21,855 | $29,140 | $36,425 | $43,710 |
| 3 | $18,310 | $24,352 | $27,465 | $36,620 | $45,775 | $54,930 |
| 4 | $22,050 | $29,327 | $33,075 | $44,100 | $55,125 | $66,150 |
| 5 | $25,790 | $34,301 | $38,685 | $51,580 | $64,475 | $77,370 |
| 6 | $29,530 | $39,275 | $44,295 | $59,060 | $73,825 | $88,590 |
| 7 | $33,270 | $44,249 | $49,905 | $66,540 | $83,175 | $99,810 |
| 8 | $37,010 | $49,223 | $55,515 | $74,020 | $92,525 | $111,030 |
| For each additional family member | $3,740 | $4,974 | $5,610 | $7,480 | $9,350 | $11,220 |
Fill out the program enrollment form located to your right. If you don’t see an enrollment form available please call Merck & Company , Inc. program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.