Get your patients started with MYALEPT

For Healthcare Providers

MYALEPT Starter Kit

All prescribers of Myalept must be certified in the Myalept REMS Program prior to prescribing Myalept.

To Certify follow these steps:

If you are already certified in the Myalept REMS program you may skip to the prescribe section.

  1. Review the Myalept Prescribing Information and Prescriber Training Module at www.myaleptrems.com.
  2. Complete, sign, and fax the Myalept REMS Program Prescriber Enrollment Form to 1-877-328-9682. Your REMS ID number will be e-mailed to you.

To Prescribe follow these steps:

  1. Complete and sign the Myalept REMS Prescription Authorization Form found at www.myaleptrems.com. Please be sure to fill out all sections of the form. Incomplete areas may delay the start of treatment.
  2. Complete and sign the ByMySide Enrollment Form (on page 4) to provide your patient access to comprehensive services including insurance coverage information, financial assistance (if eligible), injection training, fulfillment support, nutrition and dietician services, and adherence support.
  3. Have your patients complete and sign the ByMySide Patient Authorization Form (on page 5) to allow a ByMySide Coordinator to work with your patients to navigate their access and affordability options and coordinate their Myalept shipments.
  4. Fax the following completed and signed forms to 1-877-328-9682
    • Myalept REMS Prescription Authorization Form
    • ByMySide Enrollment Form
    • ByMySide Patient Authorization Form
    • Copy of patient's medical and pharmacy insurance cards (front and back)
    • Clinical notes including documentation of recent medications

For Patients

  1. Read and sign the enclosed Patient Authorization Form (on page 5) if you would like to receive Myalept product support services from ByMySide such as insurance coverage information, financial assistance (if eligible), injection training, fulfillment support, nutrition and dietitian services, and adherence support.

What's Next?

  1. Your Healthcare Provider will fax the necessary paperwork to us.
  2. You will be contacted by a ByMySide Care Manager within 2 business days to confirm your insurance coverage and delivery details, and to coordinate additional ByMySide support services. Please note this call might come from an unfamiliar phone number

ByMySide Support

To help you add Myalept to your current treatment plan, we offer a personalized support program called ByMySide with a team that's built around you. ByMySide provides the support services and resources you need when you need them. When you sign up for the ByMySide program, you can access these support services at no cost to you:

  • Insurance and financial assistance (if eligible)
  • Nurse education sessions
  • Specialty pharmacy services
  • Nutrition and dietitian services
  • Ongoing support

 

To speak with a ByMySide Coordinator, call 1-855-6MYALEPT (1-855-669-2537), Monday-Friday 8am-8pm ET