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REMS PROGRAM PRESCRIPTION FORM (sodium oxybate) oral solution 500 mg/mL Prescriber: Signature verification is required on the front page of this REMS Program Prescription Form as acknowledgment that.

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Filling out the Medication Form online is a crucial step in ensuring safe and effective treatment with . This guide will provide clear instructions to help users complete the form accurately and efficiently.

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  1. Press the ‘Get Form’ button to access the Medication Form and open it for editing.
  2. Begin by filling in the prescriber’s details, ensuring that all required fields are accurately completed. This includes the name, contact information, and any relevant identification numbers.
  3. Acknowledge the understanding of ’s approved uses by reading the prescribed information and checking the box that confirms your agreement.
  4. Next, assess and verify the patient’s medical history. Include information about any history of alcohol or substance abuse, sleep-related breathing disorders, and any concurrent use of CNS depressants.
  5. Provide counseling notes summarizing the conversation with the patient regarding the risks and precautions associated with . This should cover topics like contraindications, dosing instructions, and safe handling.
  6. Review all completed fields to ensure accuracy and completeness. Make any necessary changes prior to finalizing the form.
  7. Once all sections are thoroughly reviewed, save your changes, and proceed to download, print, or share the form as necessary.

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The firm noted that is the first and only product approved in Canada to treat cataplexy, which is a sudden loss of muscle tone associated with narcolepsy.

is a Schedule III controlled substance. The active ingredient of , sodium oxybate or gamma-hydroxybutyrate (GHB), is a Schedule I controlled substance.

The cost for oral liquid (500 mg/mL) is around $5,344 for a supply of 180 milliliters, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans. is available as a brand name drug only, a generic version is not yet available.

® is distributed through Express Scripts Specialty Distribution Services, Inc.

GHB is a Schedule I controlled substance under the Controlled Substances Act. FDA-approved products containing sodium oxybate, including and now the generic version of , are controlled under Schedule III.

is not available at your local pharmacy. As part of the XYWAV and REMS, is available only through a Certified Pharmacy. It is the only pharmacy in the United States permitted to fill the prescription and send directly to patients.

In the US, GHB is a Schedule I controlled substance, while sodium oxybate, when used under an FDA NDA or IND, was classified as a Schedule III controlled substance for medicinal use under the Controlled Substances Act, with illicit use subject to Schedule I penalties.

The Coupon Program is not prescription drug coverage or insurance. Patients cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through the Coupon Program.

Sodium oxybate is not available at retail pharmacies. Sodium oxybate is available only through a restricted distribution program called the REMS Program. It is a special program to distribute the medication and provide information about the medication.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232