Prescribing XYREM

XYREM will be dispensed and shipped only to patients who are enrolled in the XYREM® REMS Program with documentation of safe use conditions1

Prescribers should refer to the XYREM REMS Program Prescriber Brochure for details on the prescribing process.
Available at XYREMREMS.com.

Initial Prescriptions

To prescribe XYREM, prescribers will1:

complete

Complete the XYREM REMS Program Prescription Form. By signing the Prescription Form, the prescriber:

Acknowledges that he/she:
  • 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 that:
submit

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

Additional Information1:

  • All required fields must be completed clearly and accurately for timely fulfillment of the patient’s prescription. Required fields are indicated by an asterisk (*).
  • Refills and renewals may be conveyed by phone, or submitted via fax or mail using the XYREM REMS Program Prescription Form, which will be provided in advance by the Certified Pharmacy.
  • 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. Each Prescription Form is valid for 6 months from the date written (initial fill plus 5 refills per prescription).

Refill Prescriptions

For refills and renewals, simply call the Certified Pharmacy 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 also send the prescriber a refill reminder fax along with a blank XYREM REMS Program Prescription Form that can be completed and submitted via fax or mail.1

To write a XYREM refill prescription using the XYREM REMS Program Prescription Form1:

complete

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

submit

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

Additional Information1:

  • Personal prescription blanks will not be accepted.
  • Refill shipments cannot exceed a 3-month (90-day) supply. Each Prescription Form is valid for 6 months from the date written (initial fill plus 5 refills per prescription).

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

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.

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.

The Certified Pharmacy will alert you when your patients require refills and renewals. The Certified Pharmacy will send the prescriber a refill reminder fax along with a blank XYREM REMS Program Prescription Form that can be completed and submitted via fax or mail. Refills for current prescriptions may be called in to the Certified Pharmacy for the duration of the current valid Prescription Form. Each prescription is valid for 6 months from the date written (initial fill plus 5 refills per prescription).1

A prescriber office may convey refills and renewals by phone prior to a patient’s prescription expiring or running out of refills. To call in a refill or renewal, simply call the Certified Pharmacy at 1-866-XYREM88® (1-866-997-3688). The Certified Pharmacy will also send the prescriber a refill reminder fax along with a blank XYREM REMS Program Prescription Form that can be completed and submitted via fax or mail. Each Prescription Form is valid for 6 months from the date written (initial fill plus 5 refills per prescription).1

No. If you are submitting a refill or renewal to the Certified Pharmacy by fax or mail, it must be on the XYREM REMS Program Prescription Form.1