Xywav Patient Enrollment Form
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Web jazzcares may have you covered, even if you do not have coverage. Web form available online at www.xywavxyremrems.com. Web mywav is your 24/7 online tool to help provide support throughout your journey. See prescribing info and boxed warning. All prescribers must be enrolled in to xywav and xyrem rems till prescriptions xywav.
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Submit the completed and signed front page of the xywav prescription form to the certified pharmacy by either:. Enroll in the rems before you prescribe xywav for your patients, you and your patients must be enrolled in the. 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.
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