Xywav Patient Enrollment Form. Web xywav ® (calcium, magnesium, potassium, and sodium oxybates) oral solution, 0.5 g/ml total salts (equivalent to 0.413 g/ml of oxybate) is a prescription medicine used to treat:. Submit the completed and signed front page of the xywav prescription form to the certified pharmacy by either:.
Kaiser Enrollment Form Enrollment Form
Submit the completed and signed front page of the xywav prescription form to the certified pharmacy by either:. Service benefit plan prior approval p.o. Fax to xywav and xyrem rems: Web the online rems patient enrollment form can be found here. Web xywav will be dispensed and shipped only to patients who are enrolled in the xywav and xyrem rems with documentation of safe use further information is available at. Enroll in the rems before you prescribe xywav for your patients, you and your patients must be enrolled in the. Web xywav brochure for pediatric patients and their caregivers, or xyrem brochure for pediatric patients and their caregivers. Xywav and xyrem prescription forms are available for download, but must be printed,. Enroll in the rems program by completing. Web xywav ® (calcium, magnesium, potassium, and sodium oxybates) oral solution, 0.5 g/ml total salts (equivalent to 0.413 g/ml of oxybate) is indicated for the treatment of cataplexy.
Web mywav is your 24/7 online tool to help provide support throughout your journey. Web xywav brochure for pediatric patients and their caregivers, or xyrem brochure for pediatric patients and their caregivers. Web all patients must be enrolled in the rems to receive xywav. Web jazzcares for xywav offers you access to information, resources, and programs that can help support you while you are taking xywav. Web the online rems patient enrollment form can be found here. Xywav and xyrem prescription forms are available for download, but must be printed,. Web the medication is prescribed by a sleep specialist enrolled in the xywav and xyrem® rems program; Enrolls you in the xywav and xyrem rems faxes your prescription to the certified pharmacy step 2: Enroll in the rems program by completing. Fax to xywav and xyrem rems: Web xywav ® (calcium, magnesium, potassium, and sodium oxybates) oral solution, 0.5 g/ml total salts (equivalent to 0.413 g/ml of oxybate) is a prescription medicine used to treat:.
