TELL ME, wHAT IS THE XYREM® REMS PROGRAM?

TELL ME, wHAT IS THE XYREM® REMS PROGRAM?

Prescriber enrollment in the XYREM REMS Program.

Prescribers must enroll one time in the XYREM REMS Program and agree to comply with certain requirements to ensure safe use.1

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

Follow these steps to enroll yourself in the XYREM REMS Program.

1

Review

Review the XYREM full Prescribing Information (PI) and the XYREM REMS Program Prescriber Brochure.1

  • Prescribers must understand important prescribing information such as the approved indication, risks, and safe use conditions of XYREM in addition to the XYREM REMS Program requirements.1
  • The XYREM full Prescribing Information (PI) and XYREM REMS Program Prescriber Brochure are available for download at XYREMREMS.com.

2

Complete

Complete the one-time XYREM REMS Program Prescriber Enrollment Form.1

  • Prescribers need only enroll one time.1

By signing the Prescriber Enrollment Form, the prescriber...1

  • Acknowledges understanding of important information about XYREM, including approved indications and serious risks.
  • Agrees to comply with the program requirements to ensure safe use.

The XYREM REMS Program Prescriber Enrollment Form is available for download or online submission at XYREMREMS.com.

  • All required fields must be completed clearly and accurately for timely enrollment. Required fields are indicated by an asterisk (*).1

3

Submit

Submit the completed and signed XYREM REMS Program Prescriber Enrollment Form to the Certified Pharmacy by any of the following1:

send

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

mail

Scanning and emailing to
XYREMPrescribers@express-scripts.com.

location

Mailing to XYREM REMS Program,
PO Box 66589,
St. Louis, MO 63166-6589.

The Certified Pharmacy will notify you when you are enrolled and eligible to prescribe XYREM.1
need to download

Need to download forms or enroll in the program?

XYREMREMS.com
Find out how to properly dose XYREM

Find out how to properly dose XYREM.

STARTING & TITRATING XYREM

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.