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Xyrem Patient Assistance Program
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Phone
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866-997-3688
Fax:
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Eligibility
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The Xyrem Patient Assistance Program provides brand name medications at no or low cost and is intended for patients that have no prescription coverage for the needed medication. Income requirements for the program have not been disclosed. Patients must be a US citizen or legal resident. |
| Who Can Apply
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Patients must call for pre-screening. After pre-screening is complete an application will be sent the the patient if applicable. |
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Required
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The application must be completed, signed and faxed with proof of income and insurance information. The physician must also submit a prescription. The patient will be notified within 2-3 days. A new application must be submitted yearly. |
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Supply
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Supply varies. The patient must contact the company for refills. |
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Ship To
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The medication will be shipped overnight to the patient's home. |
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Note
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Both prescriber and patient must be registered with the XYREM REMS Program. |
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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.
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| sodium oxybate oral solution |
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