Enroll in the XYREM® REMS Program online.
Secure online enrollment for you and your patients.
Send a patient enrollment request.
Patients prescribed XYREM must enroll in the XYREM REMS Program. If you were previously registered in the XYREM Success Program, you will need to enroll in the XYREM REMS Program. If you are an enrolled prescriber in the XYREM REMS Program or you are transitioning from the XYREM Success Program, you can help get them started by sending a request for online enrollment using this form.
Once you send a patient enrollment request, your patient will receive an email. They can securely complete their online enrollment and submit it to be processed by the Certified Pharmacy in one step.
Both you and your patient will be notified once they have been successfully enrolled in the program.
Already a registered prescriber?
That’s great! If not, you’ll need to enroll as a prescriber first. Register now
The XYREM REMS Program uses DocuSign to make it easy to enroll online.
Your information is securely submitted using DocuSign, the most widely used electronic signature.
Frequently Asked Questions
Questions about online enrollment? Please review below for answers to the most common questions we receive. If you still have questions or are in need of support, you can send them to firstname.lastname@example.org.
Didn’t see the answers you were looking for?
Contact us at email@example.com
for assistance and general support.