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Patient Assistance Information

 
1 Program for Xyrem
 
 
Xyrem Patient Assistance Program

Xyrem Patient Assistance Program
C/O NORD
Danbury, CT 06813-1968
Phone : 866-997-3688
Fax: 203-798-2964
Eligibility
> The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. The patient must also be a US resident or legal alien.
Who Can Apply
> The doctor/doctor's office must call for a prescreening.
Required
> The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income and any insurance information.
Supply
>
Ship To
> Patient's home
Note
> The doctor/doctor's office must call for a prescreening.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Xyrem