Insurance Coverage

Will insurance pay for XYREM^®?

In 2007, XYREM was covered by over 80% of all private insurance plans. A team member from the pharmacy will contact the patient and the patient's insurance plan to coordinate coverage for XYREM.[1]

What is the pharmacy's role with insurance?

An experienced Reimbursement Specialist will:

Contact the patient to review their benefits and eligibility
Inform the patient of co-pay responsibility, if applicable
Obtain prior authorization from the insurance company, if needed
File appropriate appeals on the patient's behalf
Assist with obtaining alternate funding that may be available to the patient
Support the patient with all aspects of insurance

The pharmacy's attempt to obtain coverage from a patient's third-party payer does not guarantee success.[1]

Important Information

Neither Jazz Pharmaceuticals nor the XYREM Success Program^® guarantees reimbursement coverage for XYREM. In addition, neither Jazz Pharmaceuticals nor the XYREM Success Program assumes liability related to coverage and reimbursement for XYREM.

These materials are provided to you as guidance only and not a substitute for direct discussions with payers. Proper coding of claims is solely the responsibility of providers. Jazz Pharmaceuticals and the XYREM Success Program do not guarantee or warrant reimbursement coverage or reimbursement levels, as this is at the exclusive discretion of the payer. The information is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, policies, and payment amounts. Local payers, even local Medicare contractors, establish their own coverage, coding, and payment policies that might vary from what is provided in the guide. Information provided is for example only.

If you have any questions, please call 1-866-XYREM88^® (1-866-997-3688).

References:

^ The XYREM Success Program® for Patients, Jazz Pharmaceuticals, Inc.

Important Safety Information

1. XYREM^® is a controlled substance. Controlled substances are medicines that, if abused, may lead to varying degrees of physical or psychological dependence. XYREM is a Schedule III drug — which means that it has a moderate dependence liability. If you sell, distribute, or give your XYREM to anyone else or use it for purposes other than what it was prescribed for, you may be punished under federal and state law by jail and fines.

2. It is very important to keep XYREM out of reach of children and pets.

3. XYREM can cause serious side effects including trouble breathing while asleep, confusion, abnormal thinking, depression and loss of consciousness. Tell your doctor if you have any of these problems while taking XYREM.

BOXED WARNING:

!Warning

Central Nervous System Depressant with Abuse Potential. Should not be used with alcohol or other CNS depressants. Sodium oxybate is a form of GHB, a known drug of abuse. Abuse has been associated with some important central nervous system (CNS) adverse events (including death). Even at recommended doses, use has been associated with confusion, depression, and other neuropsychiatric events. Reports of respiratory depression occurred in clinical trials. Almost all of the patients who received sodium oxybate during clinical trials were receiving CNS stimulants.

Important CNS adverse events associated with abuse of GHB include seizure, respiratory depression and profound decreases in level of consciousness, with instances of coma and death. For events that occurred outside of clinical trials, in people taking GHB for recreational purposes, the circumstances surrounding the events are often unclear (e.g., dose of GHB taken, the nature and amount of alcohol or any concomitant drugs).

XYREM is available through the XYREM Success Program^®, using a centralized pharmacy 1-866-XYREM88^® (1-866-997-3688). The Success Program provides educational materials to the prescriber and the patient explaining the risks and proper use of sodium oxybate, and the required prescription form. Once it is documented that the patient has read and/or understood the materials, the drug will be shipped to the patient. The XYREM Success Program also recommends patient follow-up every 3 months. Physicians are expected to report all serious adverse events to the manufacturer.