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Which medication are you requesting co-pay assistance for?

MAVENCLAD^® (cladribine) 10 mg tablets

Rebif^® (interferon beta-1a) subcutaneous injection

Please see MAVENCLAD full Prescribing Information and Medication Guide, including serious side effects at links
above.

Please see Rebif full Prescribing Information and Medication Guide at links above.

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EMD Serono is the Healthcare business of Merck KGaA, Darmstadt, Germany in the U.S. and Canada.
MAVENCLAD, Rebif, and MS LifeLines are registered trademarks of Merck KGaA, Darmstadt, Germany or its affiliates.
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US-MULNI-00392 10/2024

MS LifeLines Co-Pay Assistance Program

All field(s) are required unless otherwise specified.