JazzCares is designed to give you the support and assistance you need, right from the start, and throughout your treatment journey.

Sign the Patient Authorization Form and enroll now to see if you are eligible for the JazzCares support services described below

SIGN NOW
Patient Advocate University

Guiding Your Patients to Therapy: 5 Welcome Steps

Learn More
nursing

Personalized Resources, Nursing, and Pharmacy Support

Online Refill Scheduling

Never run out of your medication. Refilling your XYREM is easy and convenient with our online refill scheduling and reminder. Sign up to receive email and text reminders today. Call the pharmacy at 1-866-997-3688 to sign up!

Nursing Support

Your dedicated Nurse Case Manager assesses your unique needs, and can help you navigate social support, address practical challenges, and help motivate you!

Pharmacy Support

Through the Certified Pharmacy, a pharmacist is available 24/7 to answer questions about your prescription.

cards

Savings and Support Programs

Coupon Program

Only pay as little as $35 for XYREM. A little support can make a big difference in staying on track with your treatment.

Quick Start Voucher

Are you waiting for your insurance to cover XYREM? You may be eligible to receive a free 1-month supply of XYREM with the Quick Start Voucher.

Bridge Program

Life can change quickly. Your treatment with XYREM may stay constant. The Bridge Program can provide eligible patients up to 4 months of XYREM for free.

money

Patient Assistance Program

JazzCares may have you covered, even if you do not have coverage. Enroll in the Patient Assistance Program as advised by the Certified Pharmacy.

ENROLL NOW

If you are uninsured or your insurance does not cover XYREM, you may be eligible to receive treatment for free.

Terms and Conditions

Coupon Program

Eligible patients can pay as little as $35 for XYREM for a 30-day fill, subject to monthly and annual maximum benefit. The Coupon Program is only available for residents of the US, Puerto Rico, and the other US territories who have commercial insurance with out-of-pocket expenses, including co-pay/co-insurance/plan deductibles exceeding $35 (for XYREM) per 30-day prescription fill. The Coupon Program is for commercially insured patients that have been prescribed XYREM. The XYREM Coupon Program is not valid for beneficiaries of Medicare, Medicaid, VA, or other federal or state healthcare programs, if you pay for your prescription in cash or if you choose not to use your insurance coverage. The Coupon Program requires a valid, signed prescription for XYREM. The Coupon Program is for patients enrolled in the XYREM and XYREM REMS. The pharmacy will bill your insurance for the portion that your insurance plan has agreed to cover. The XYREM Coupon Program is not health insurance. The pharmacy, patient, or prescriber cannot submit a claim for reimbursement under any federal, state, or other governmental programs or any third party for any part of the benefit received by the patient through the Coupon Program. By using this offer, patients certify that they will comply with any terms of their health insurance contract requiring notification to their payor of the existence and/or value of this offer. It is illegal to (or offer to) sell, purchase, or trade this offer. This offer is non-transferrable. This offer is void where prohibited by law. No purchase necessary. The Coupon may not be applied retroactively. If your insurance changes, you must inform the pharmacy immediately. Based on your insurance change, you may no longer be able to participate in the XYREM Coupon Program. Jazz Pharmaceuticals reserves the right to terminate or modify this program at any time and without notice and in its sole discretion. In order to facilitate the XYREM Coupon Program, you understand and agree that Jazz will process your personal information in accordance to Jazz Pharmaceuticals' Privacy Policy which can be found at www.jazzcares.com.

Quick Start Voucher

The voucher is good for up to one-month’s free supply (maximum of three bottles) for a patient’s first-time shipment. There is a lifetime limit of one voucher per patient. The voucher is for commercially insured patients that have been prescribed XYREM for its FDA-approved indications. The voucher is only available for residents of the US, Puerto Rico, and the other US territories. The voucher is not valid for beneficiaries of Medicare, Medicaid, VA, or other federal or state healthcare programs. The voucher requires a valid, signed prescription for XYREM. The voucher is for patients enrolled in the XYREM and XYREM REMS. The voucher is for patients that are experiencing an insurance coverage decision delay greater than 10 calendar days for XYREM or for patients changing from XYREM who are at risk of therapy interruption (i.e., less than seven calendar days from the patient’s next XYREM delivery date). The voucher may not be submitted by the patient, pharmacy, or prescriber to seek reimbursement for all or any part of the benefit received by the patient through this voucher. The free supply of XYREM cannot be used toward any out-of-pocket costs under any health insurance or prescription drug plan. The voucher may not be applied retroactively and does not cover refills. The voucher cannot be combined with any other voucher, certificate, coupon, rebate, or similar offer. Use of the voucher is not contingent on any purchase requirement. This is not a discount, rebate, or insurance program. The voucher is not valid where otherwise prohibited by law. It is illegal for any person to sell, purchase, trade, or counterfeit the voucher. Jazz Pharmaceuticals reserves the right to terminate or modify this program any time with or without notice. In order to facilitate the XYREM Quick Start Voucher, you understand and agree that Jazz will process your personal information in accordance to Jazz Pharmaceuticals' Privacy Policy which can be found at www.jazzcares.com.

Bridge Program

The Bridge Program is for patients who have commercial insurance that are at risk of therapy interruption due to a change in insurance or change in insurance coverage for XYREM. The Bridge Program benefit is a free drug offer valid for up to a one hundred and twenty (120) day supply of XYREM or until commercial insurance coverage has been established or you have transitioned to a different therapy or discontinued therapy, whichever comes first, given in up to fifteen (15) day increments. The Bridge Program is only available for residents of the US, Puerto Rico, and the other US territories. The Bridge Program is for patients that have been prescribed XYREM for its FDA-approved indications. The Bridge Program is not valid for beneficiaries of Medicare, Medicaid, VA, or other federal or state healthcare programs, if you pay for your prescription in cash or if you choose not to use your insurance coverage. The Bridge Program requires a valid, signed prescription for XYREM. The Bridge Program is for patients enrolled in the XYREM and XYREM REMS. The Bridge Program is not health insurance. The pharmacy, patient, or prescriber cannot submit a claim for reimbursement under any federal, state, or other governmental programs or any third party for any part of the benefit received by the patient through the Bridge Program. It is illegal to (or offer to) sell, purchase, or trade this offer. This offer is non-transferrable. This offer is void where prohibited by law. No purchase necessary. If your insurance changes, you must inform the pharmacy immediately. Based on your insurance change, you may no longer be able to participate in the XYREM Bridge Program. Jazz Pharmaceuticals reserves the right to terminate or modify this program at any time and without notice and in its sole discretion.

Patient Assistance Program

Terms and Conditions apply.

Resources

JazzCares Patient Authorization Form:

In order to receive JazzCares services, please complete, sign, date, and mail the JazzCares Patient Authorization to the JazzCares Program, PO Box 66589, St. Louis, MO, 63166-6589

Download (English) Download

Patient Assistance Program Application:

Complete, sign, date, and mail the Patient Assistance Program application to JazzCares Patient Assistance Program, PO Box 66589, St. Louis, MO, 63166-6589

Download
You can learn more about JazzCares support
offerings by calling
1-833-533-JAZZ (5299)Monday-Friday, 8 AM-8 PM ET
Insurance coverage and plans may vary. The JazzCares program at Jazz Pharmaceuticals provides general information only and is not a guarantee of any coverage or reimbursement outcome. All treatment decisions rest solely with the treating physician or qualified healthcare professional. Jazz Pharmaceuticals reserves the right to terminate or modify this program at any time with or without notice. Other terms and conditions apply.