Relyvrio Prescribing & Dosing Schedule

Dosage & Administration Drug label Prior authorization Financial assistance Patient education People also ask

Relyvrio(phenylbutyrate / taurursodiol)

relyvrio 3 GM / 1 GM Powder for Oral Suspension

NO BOXED WARNING

Dosage & Administration

* The recommended dosage is 1 packet (3 g sodium phenylbutyrate and 1 g taurursodiol) administered orally or via feeding tube as follows:
* Initial dosage: 1 packet daily for the first 3 weeks
* maintenance dosage: 1 packet twice daily thereafter

* Empty contents of one packet in a cup containing 8 ounces of room temperature water and stir vigorously prior to administration.
* Take within 1 hour of preparation.
* Administer RELYVRIO before a snack or meal.

drug label

Relyvrio Prescribing Information

Report Adverse Event

prior authorization

Relyvrio Prior Authorization Resources

Most recent state uniform prior authorization forms

Verified: Jun 26, 2024Arizona - Uniform Prior Authorization Form

Verified: Jun 26, 2024Colorado - Uniform Prior Authorization Form

Verified: Jun 26, 2024Hawaii - Uniform Prior Authorization Form

Verified: Jul 26, 2024Illinois - Uniform Prior Authorization Form

Verified: Jun 26, 2024Indiana - Uniform Prior Authorization Form

Verified: Jun 26, 2024Louisiana - Uniform Prior Authorization Form

Verified: Jun 26, 2024Minnesota - Uniform Prior Authorization Form

Verified: Jun 26, 2024New Hampshire - Uniform Prior Authorization Form

Verified: Jun 26, 2024New Mexico - Uniform Prior Authorization Form

Verified: Jun 26, 2024Oregon - Uniform Prior Authorization Form

Verified: Jun 26, 2024Texas - Uniform Prior Authorization Form

Verified: Jul 07, 2024Washington - Uniform Prior Authorization Form

Verified: Jul 07, 2024Wisconsin - Uniform Prior Authorization Form

Complete Letter of Medical Necessity

Coverage Authorization Appeals

Benefits investigation

Relyvrio Enrollment Form

financial assistance

Relyvrio Financial Assistance Options

Copay savings program

Relyvrio Enrollment Form

Enroll in Patient Savings Program

Learn More

Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Bridge program

Relyvrio Enrollment Form

Interim Rx (Bridge) Program

Learn More

Overview

Provide patient immediate access to therapy during an insurance delay (typically new starts; some may cover change in insurance)
Limited time/ fill (typically 7-30 days; some may offer additional fill for continued delay up to certain limit)

Patient benefit

100% free (outside of insurance)

Patient eligibility

HCP must enroll patient
May be limited to commercially insured patients (i.e., no government beneficiaries); some programs may allow government beneficiaries

How to sign up

Typically HCP assisted enrollment (via form)

Foundation programs

Relyvrio Enrollment Form

Learn More

Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and copays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement

patient education

Relyvrio Patient Education

Getting started on Relyvrio

Instructions For Use: ALS

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link

Patient toolkit

About Relyvrio

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

View How to Take Relyvrio

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

Patient Resources

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

Patient Brochure

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

What To Expect With Relyvrio

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

ACT Support Program Brochure

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

Relyvrio FAQs

How is the dosage of Relyvrio?Relyvrio is available in 1 dosages, including 3,000-1,000 mg Pwdr

What does Relyvrio treat?Relyvrio treats Amyotrophic Lateral Sclerosis, Sickle Cell Anemia, Cystic Fibrosis, Myeloproliferative Disorders and beta-Thalassemia

How Is Relyvrio Administered?Relyvrio is administered as a Oral Suspension Powder

FAQ Data Source

Dosage & Administration

Dosage & Administration

drug label

Relyvrio Prescribing Information

prior authorization

Relyvrio Prior Authorization Resources

Most recent state uniform prior authorization forms

Benefits investigation

financial assistance

Relyvrio Financial Assistance Options

Copay savings program

Bridge program

Foundation programs

patient education

Relyvrio Patient Education

Getting started on Relyvrio

Patient toolkit

people also ask

Relyvrio FAQs