Contact info
- Phone
- 1-866-997-3688
- Fax
- 1-866-470-1744
Eligibility
- Prescribing Physician, Healthcare Facilities, Pharmacies and Patients must enroll into the Risk Evaluation and Mitigation Strategy (REMS) Program prior to initiating the patient on treatment with Xyrem.
- Co-pay assistance and patient assistance programs are available for eligible patients. Contact program for details.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Not published
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Proof of income
- Prescriber license number
- Not published
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Not published
Getting the medication
- Patient receives
- Varies
- Shipped to
- Patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
Medications covered
- Xyrem (gammahydroxybutyrate)