XYREM Success Program^® for Physicians

The procedure for writing and dispensing XYREM^® prescriptions is outlined below. The central pharmacy with the XYREM Success Program^® is available at 1-866-XYREM88^® (1-866-997-3688) to support you, your staff and your patients, and to answer any questions you might have.

Before prescribing XYREM

• Prescribing XYREM requires entry into a physician registry
• To do so, complete the Physician Registration Form and return it to the pharmacy.

Prescribing Requirements

• Confirm that each patient for whom you prescribe XYREM has been educated with respect to XYREM preparation, dosing and scheduling, and whether you have given the patient a copy of the patient education materials.
• Since optimal patient response often requires dose titration, you should evaluate your patients frequently during the early stages of treatment.
• The recommended starting dose is 4.5 grams nightly taken in equally divided doses of 2.25 grams. Each patient’s dose may be titrated within the effective dose range of 6–9 grams/night.
• Once stable dosage is established, patients should be evaluated and prescriptions rewritten every 3 months.

Prescription Form

• Fax the completed XYREM Patient Enrollment Form and Prescription Form and all subsequent prescriptions to the pharmacy at 1-866-470-1744.
• Patients are entered in a registry maintained at the pharmacy.

Central Pharmacy’s Role

Following receipt of your prescription, the pharmacy will:

• Send confirmation of each prescription received to your office.
• Request additional information or clarification if necessary.
• Contact the patient’s insurance provider to verify benefits and eligibility.
• Contact the patient to:
  • Confirm that you have educated the patient regarding the XYREM Patient Success Program, and given the patient a copy of the education materials. If not, the pharmacy will educate the patient.
  • Confirm XYREM delivery details.
  • Review preparation, administration and storage instructions.
• Dispense and ship XYREM by overnight courier to the patient or his/her designee.
• Send XYREM Patient Success Program materials to the patient with the first XYREM shipment, if you have not already provided them.
• Maintain a patient and prescriber enrollment.

© 2012 Jazz Pharmaceuticals Inc.