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“Tell me, how is XYREM prescribed?”

Prescribing XYREM for your patients.

XYREM will be dispensed and shipped only to patients who are enrolled in the XYREM® REMS Program with documentation of safe use conditions.1

  • Prescribers should refer to the XYREM REMS Program Prescriber Brochure for details on the prescribing process, available for download at XYREMREMS.com.

Follow these steps for initial XYREM prescriptions.

1

Complete the XYREM® REMS Program Prescription Form.1

By signing the Prescription Form, the prescriber...

Acknowledges that he or she1:

  • Has read and understands the XYREM full Prescribing Information (PI) and the XYREM REMS Program Prescriber Brochure.
  • Understands the approved indications, risks, and safe use conditions of XYREM.

Attests that1:

2

Submit the completed and signed front page of the XYREM REMS Program Prescription Form to the Certified Pharmacy by either1:

send
Faxing to
1-866-470-1744 (toll-free).
send

Mailing to
XYREM REMS Program,

PO Box 66589,

St. Louis, MO 63166-6589.

Keep the following additional information in mind.

  • All required fields must be completed clearly and accurately for timely fulfillment of the patient’s prescription. Required fields are indicated by an asterisk (*).1
  • Personal prescription blanks will not be accepted.
  • The patient’s first shipment of XYREM will be limited to a 1-month (30-day) supply, and refill shipments cannot exceed a 3-month (90-day) supply.1
  • Each Prescription Form is valid for 6 months from the date written (initial fill plus 5 refills per prescription).1

The Prescription Form is used for initial prescriptions and for patients who are reinitiating XYREM after a lapse in therapy of 6 months or longer.1

The Prescription Form can also be used for refills and renewals.1

Simply call the Certified Pharmacy to refill or renew a XYREM prescription.1

  • The Certified Pharmacy can be reached at 1-866-XYREM88® (1-866-997-3688).1
  • A prescriber office may convey refills and renewals by phone prior to a patient’s prescription expiring or running out of refills.1
  • The Certified Pharmacy will send the prescriber a refill reminder fax when a prescription is expiring or out of refills.1

You can also refill or renew a XYREM prescription using the XYREM REMS Program Prescription Form.

1

Complete the XYREM REMS Program Prescription Form using the same procedure described for the initial prescription.1

2

Submit the completed and signed front page of the XYREM REMS Program Prescription Form to the Certified Pharmacy by either1:

send
Faxing to
1-866-470-1744 (toll-free).
send

Mailing to
XYREM REMS Program,

PO Box 66589,

St. Louis, MO 63166-6589.

Keep the following additional information in mind.

  • All required fields must be completed clearly and accurately for timely fulfillment of the patient’s prescription. Required fields are indicated by an asterisk (*).1
  • Personal prescription blanks will not be accepted.
  • Refill shipments cannot exceed a 3-month (90-day) supply.1
  • Each Prescription Form is valid for 6 months from the date written (initial fill plus 5 refills per prescription).1

The Prescription Form is used for initial prescriptions, and for patients who are reinitiating XYREM after a lapse in therapy of 6 months or longer.1

The Prescription Form can also be used for refills and renewals.1

Xyrem checklist icon

Need to download forms or enroll in the program?

XYREMREMS.com
Xyrem bottle icon

Find out about proper XYREM dosing for adult patients.

DOSING & TITRATING XYREM
IN ADULTS
Xyrem bottle icon

Find out about proper XYREM dosing for pediatric patients.

DOSING & TITRATING XYREM IN
PEDIATRIC PATIENTS

Need help? Have questions? Get answers.

For further information, visit or call

XYREMREMS.com |
1-866-XYREM88®

(1-866-997-3688).

A Nurse Case Manager is available Monday – Friday, 7 AM – 8 PM, Central Time.
A pharmacist is available 24 hours a day, 7 days a week.