Xywav Prescription Form PDF

Xywav Prescription Form PDF - Prescribed by one of the following a Neurologist b Psychiatrist c Pulmonologist Sleep Medicine Specialist Authorization will be issued for 3 months Reauthorization Xyrem or Xywav will be approved for continuation of therapy based on one of the following criteria

1 Fax to the XYWAV and XYREM REMS 1 866 470 1744 toll free 2 OR mail to the XYWAV and XYREM REMS PO Box 66589 St Louis MO 63166 6589 3 OR scan and email to the XYWAV and XYREM REMS at ESSDSPrescribers express scripts Note Prescribers and patients who are actively enrolled in the XYREM REMS are not required to re enroll in the XYWAV

Xywav Prescription Form PDF

Xywav Prescription Form PDF

Complete and submit form online at XYWAVXYREMREMS.com, OR scan and e-mail to [email protected], OR fax to XYWAV and XYREM REMS at 1-866-470-1744 (toll free), OR mail to XYWAV and XYREM REMS, PO Box 66589, St. Louis, MO 63166-6589. For more information, please call the XYWAV and XYREM REMS at 1-866-997-3688 (toll free).

Form available online at XYWAVXYREMREMS Print sign and Fax to XYWAV and XYREM REMS 1 866 470 1744 toll free OR mail to XYWAV and XYREM REMS PO Box 66589 St Louis MO 63166 6589 For more information call the XYWAV and XYREM REMS at 1 866 997 3688 toll free

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Overview XYWAV is indicated for the treatment of cataplexy or excessive daytime sleepiness in patients 7 years of age and older with narcolepsy XYWAV is indicated for the treatment of idiopathic hypersomnia IH in adults

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XYWAV is a prescription medicine used to treat patients 7 years of age and older with narcolepsy to reduce too much daytime sleepiness and to reduce cataplexy suddenly weak or paralyzed muscles XYWAV is also used to treat idiopathic hypersomnia IH in adults IMPORTANT INFORMATION ABOUT XYWAV INCLUDES THE FOLLOWING

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Administer XYWAV at least 2 hours after eating 2 4 Prepare XYWAV prior to bedtime dilute with approximately cup of water in pharmacy provided containers 2 4 Take XYWAV while in bed and lie down after dosing 2 4 For Patients Transitioning from Xyrem to XYWAV Initiate at the same dose and regimen as Xyrem gram for gram

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Complete and submit form online at XYWAVXYREMREMS OR scan and e mail to ESSDSPrescribers express scripts OR fax to XYWAV and XYREM REMS at 1 866 470 1744 toll free OR mail to XYWAV and XYREM REMS PO Box 66589 St Louis MO 63166 6589 For more information please call the XYWAV and XYREM REMS at 1 866 997 3688 toll free

1Your doctor will enroll you in the XYWAV and XYREM REMS (if you're not already enrolled), send your prescription to the Certified Pharmacy, and work with the pharmacy to initiate the insurance process.

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The REMS Prescriber Enrollment Form Patient Enrollment Form and XYWAV Prescription Form or XYREM Prescription Form must be completed in full and sent to the XYWAV and XYREM REMS

Xywav Prescription Form PDF

Complete and submit form online at XYWAVXYREMREMS OR scan and e mail to ESSDSPrescribers express scripts OR fax to XYWAV and XYREM REMS at 1 866 470 1744 toll free OR mail to XYWAV and XYREM REMS PO Box 66589 St Louis MO 63166 6589 For more information please call the XYWAV and XYREM REMS at 1 866 997 3688 toll free

1 Fax to the XYWAV and XYREM REMS 1 866 470 1744 toll free 2 OR mail to the XYWAV and XYREM REMS PO Box 66589 St Louis MO 63166 6589 3 OR scan and email to the XYWAV and XYREM REMS at ESSDSPrescribers express scripts Note Prescribers and patients who are actively enrolled in the XYREM REMS are not required to re enroll in the XYWAV

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