Patient Enrollment

Patients must be enrolled one time in the XYREM® REMS Program1

Prescribers should refer to the XYREM REMS Program Prescriber Brochure for details on patient enrollment requirements. Available at XYREMREMS.com.

To enroll a patient in the XYREM REMS Program, prescribers will1:

screen

Screen

Screen each patient for certain medical conditions and concomitant medications.

See Patient Screening, Counseling, & Evaluation.

counsel

Counsel

Counsel each patient on the serious risks, safe use, handling, and storage of XYREM as described in the XYREM REMS Program Patient Quick Start Guide.

See Patient Screening, Counseling, & Evaluation.

Review:

Review the contents of the XYREM REMS Program Patient Quick Start Guide with each patient.

Encourage:

Encourage all patients to read the XYREM Medication Guide and to ask any questions they may have regarding treatment with XYREM.

complete

Complete

Complete the one-time XYREM REMS Program Patient Enrollment Form

Both the prescriber and the patient must sign the Patient Enrollment Form available for download or online submission at XYREMREMS.com. By signing:

  • The patient acknowledges that he/she has been counseled on the serious risks and safe use of XYREM and has asked any questions he/she had about XYREM.
  • The prescriber acknowledges that he/she has counseled the patient about the serious risks associated with XYREM and the safe use conditions.
All required fields must be completed clearly and accurately for timely enrollment. Required fields are indicated by an asterisk (*).

Prescribers must be enrolled in the XYREM REMS Program prior to enrolling patients.

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

submit Submit

Submit the completed and signed XYREM REMS Program Patient Enrollment Form to the Certified Pharmacy.

The Certified Pharmacy will notify prescribers when the patient is successfully enrolled and eligible to receive XYREM.1

Download Forms or Enroll Your Patient at Xyremrems.Com

Need Help? Have Questions?

Call the XYREM REMS Program hotline anytime.

The Certified Pharmacy provides 24/7 toll-free access to a pharmacist to help answer any questions or concerns the prescriber, office staff, or patients may have regarding safety, dosing, and patient care.

Frequently Asked Questions

Yes. All patients must be enrolled in the XYREM REMS Program, using the XYREM REMS Program Patient Enrollment Form, prior to having their first XYREM prescription filled. The Certified Pharmacy will notify the prescriber when the patient is successfully enrolled and eligible to receive XYREM.1

To enroll a patient in the XYREM REMS Program, prescribers must screen each patient for certain medical conditions and concomitant medications and counsel each patient on the serious risks, safe use, handling, and storage of XYREM. Prescribers must review the contents of the XYREM REMS Program Patient Quick Start Guide with each patient and encourage all patients to read the XYREM Medication Guide and to ask any questions they may have regarding treatment with XYREM.1

After screening and counseling the patient, prescribers must complete the one-time XYREM REMS Program Patient Enrollment Form. Both the patient and the prescriber must sign and date this form to acknowledge that the patient has been counseled about the serious risks and safe use of XYREM and that he or she has asked any questions he or she had about XYREM. Prescribers must submit the completed and signed Patient Enrollment Form to the Certified Pharmacy by either faxing to 1-866-470-1744 (toll free) or mailing to XYREM REMS Program, PO Box 66589, St. Louis, MO 63166-6589.1 Secure online enrollment is also available at XYREMREMS.com.

Prescribers should refer to the XYREM REMS Program Prescriber Brochure for details on patient enrollment requirements.

The XYREM REMS Program is designed to ensure that all patients are educated on and understand the serious risks and safe use conditions of XYREM. The patient signs the XYREM REMS Program Patient Enrollment Form to acknowledge that the prescriber has counseled him or her on the serious risks and safe use of XYREM and that he or she has asked the prescriber any questions he or she may have had about XYREM.1

Editable versions of the XYREM REMS Program Prescriber Enrollment Form and XYREM REMS Program Patient Enrollment Form, as well as secure online prescriber and patient enrollment, are available at XYREMREMS.com. All required forms can also be obtained by contacting a Jazz Pharmaceuticals Specialty Sales Consultant (SSC) or calling the Certified Pharmacy. XYREM REMS Program Prescription Forms are not available online.

The XYREM REMS Program education material can be downloaded from XYREMREMS.com. The XYREM REMS Program education material may also be obtained by contacting a Jazz Pharmaceuticals Specialty Sales Consultant (SSC) or calling the Certified Pharmacy.

Yes. Secure online enrollment for prescribers and patients is available at XYREMREMS.com. The XYREM REMS Program Prescriber Enrollment Form can also be scanned and submitted via email.

The XYREM REMS Program Prescription Form is not available electronically.

In addition to confirming receipt of all completed forms, the Certified Pharmacy will reach out to the designated office contact or prescriber to notify him or her if any form contains insufficient or incorrect information.1

For the XYREM REMS Program Prescriber Enrollment Form and XYREM REMS Program Patient Enrollment Form, the Certified Pharmacy can verbally obtain certain missing information (ie, demographic information) by contacting the prescriber office, and complete the enrollment process. Forms will be returned to the prescriber if checkboxes or signature/date fields are left blank. All forms will be returned to the prescriber if the Certified Pharmacy is unable to reach the prescriber via phone. In these cases, the prescriber will receive a fax notification including a copy of the submitted form, with instructions to complete and resubmit the form to the Certified Pharmacy.