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Xyrem Patient Assistance Program
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Xyrem Patient Assistance Program
C/O NORD
Danbury, CT 06813-1968
Phone
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866-997-3688
Fax:
203-798-2964
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Eligibility
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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
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The doctor/doctor's office must call for a prescreening. |
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Required
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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. |
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Supply
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Ship To
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Patient's home |
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Note
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The doctor/doctor's office must call for a prescreening. |
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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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| Xyrem |
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