1 Prescriber Certification
To become certified, each prescriber must complete a XYWAV and XYREM REMS Prescriber Enrollment Form once and submit it to the XYWAV and XYREM REMS via one of the options below. Before enrolling in the XYWAV and XYREM REMS, ensure you’re familiar by reviewing the resources here:
OPTION 1
Submit Online
By using DocuSign, the XYWAV and XYREM REMS can ensure that your personal information can stay safe, secure, and protected.
OPTION 2
Download Prescriber Enrollment Form
The enrollment process for prescribers is quick, easy, and secure—simply complete the enrollment form and submit it to the XYWAV and XYREM REMS for processing. For best results, use Adobe Acrobat to fill out the forms.
Scan and Email to:
Fax to:
XYWAV and XYREM REMS
1-866-470-1744 (toll free)
Mail to:
XYWAV and XYREM REMS
PO Box 66589
St. Louis, MO 63166-6589
2 Patient Enrollment
OPTION 1
Submit Online
If you begin patient enrollment online, your patient will receive an e-mail to complete their portions of the form, including an e-signature. Then, you will electronically submit the form to the XYWAV and XYREM REMS. Both you and your patient will be notified when enrollment in the program is successful.
OPTION 2
Download Patient Enrollment Form
Print the enrollment form to have your patient sign it in your office. You will then submit it to the XYWAV and XYREM REMS by e-mail, fax, or mail. For best results, please use Adobe Acrobat to fill out the forms prior to printing.
Scan and Email to:
Fax to:
XYWAV and XYREM REMS
1-866-470-1744 (toll free)
Mail to:
XYWAV and XYREM REMS
PO Box 66589
St. Louis, MO 63166-6589
3 Prescribe XYWAV & XYREM
To prescribe XYWAV and XYREM, the prescriber must be certified and the patient enrolled in the XYWAV and XYREM REMS.
OPTION 1
Submit Electronic Prescription Forms
To submit the XYWAV or XYREM Prescription Form online for your patient, select the ePrescribe Now button. Completed electronic prescriptions are submitted directly to the XYWAV and XYREM REMS.
OPTION 2
Download Prescription Forms
If you prefer to not use electronic prescriptions, the XYWAV and XYREM Prescription Forms are available to download, but must be printed, signed, and sent by Fax or Mail to the XYWAV and XYREM REMS.
Fax to:
XYWAV and XYREM REMS
1-866-470-1744 (toll free)
Mail to:
XYWAV and XYREM REMS
PO Box 66589
St. Louis, MO 63166-6589
