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How ACT assists your practice

How ACT works with you to support your patients

We can provide vital support by helping to:

  • Investigate insurance benefits
  • Explain the prior authorization (PA) process and follow up on the status of submitted PAs
  • Explore comprehensive financial assistance programs that are available for eligible patients*
    • $0 Co-Pay Program

      Patients with commercial insurance may be eligible for the co-pay assistance program.

    • Interim Access Program

      Patients may be eligible to receive up to 2 months’ supply of product if they experience a delay in getting their prescription approved by their insurance company.

    • Patient Assistance Program

      If the patient does not have insurance or does not have insurance that covers their treatment, they may qualify to receive RELYVRIO at no cost.

  • Coordinate with specialty pharmacies to:
    • Support timely medication fulfillment
    • Deliver RELYVRIO to your patients’ doorsteps
ACT Care Coordinators provide you with vital support

We believe every person living with ALS deserves personalized support—and we are determined to deliver it.

Jennifer, ACT Care Coordinator
Jennifer

ACT Care Coordinator

*Individuals must meet eligibility criteria to qualify for assistance. Amylyx reserves the right to make individual eligibility determinations based on its program rules and to modify or discontinue any program at any time.

HCP resources

Download the RELYVRIO Enrollment Form

RELYVRIO Enrollment Form

Use this form to get your patients started with RELYVRIO and enrolled in ACT.

See the guide to the RELYVRIO Enrollment Form below to learn how to complete the form.

Download
Download the Guide to the RELYVRIO Enrollment Form PDF

ACT Enrollment Form Guide

Helpful information on how to get your patients started with RELYVRIO and tips on completing the RELYVRIO Enrollment Form.

Download
Download the Sample Letter of Appeal

Sample Letter of Appeal

Use this template to help you write a letter of appeal to reviewers on behalf of your patient.

Download
Download the Sample Letter of Medical Necessity

Sample Letter of Medical Necessity

Use this template to help you write a letter of medical necessity on behalf of your patient, including a summary of the patient’s history and rationale for treatment.

Download
Download the Navigating Coverage for RELYVRIO image

Navigating Coverage for RELYVRIO

An educational resource to help you navigate the access and fulfillment process for RELYVRIO.

Download
Download the Understanding Health Insurance image

Understanding Health Insurance

Learn about health insurance options to help you answer questions from people living with ALS and their caregivers.

Download
IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS
Risk in Patients With Enterohepatic Circulation Disorders, Pancreatic Disorders, or Intestinal Disorders
RELYVRIO contains taurursodiol, which is a bile acid. In patients with disorders that interfere with bile acid circulation, there may be an increased risk for worsening diarrhea, and patients should be monitored appropriately for this adverse reaction. Pancreatic insufficiency, intestinal malabsorption, or intestinal diseases that may alter the concentration of bile acids may also lead to decreased absorption of either of the components of RELYVRIO. Because different enterohepatic circulation, pancreatic, and intestinal disorders have varying degrees of severity, consider consulting with a specialist. Patients with disorders of enterohepatic circulation (eg, biliary infection, active cholecystitis), severe pancreatic disorders (eg, pancreatitis), and intestinal disorders that may alter concentrations of bile acids (eg, ileal resection, regional ileitis) were excluded from the study; therefore, there is no clinical experience in these conditions.
Use in Patients Sensitive to High Sodium Intake
RELYVRIO has a high salt content. Each initial daily dosage of 1 packet contains 464 mg of sodium; each maintenance dosage of 2 packets daily contains 928 mg of sodium. In patients sensitive to salt intake (eg, those with heart failure, hypertension, or renal impairment), consider the amount of daily sodium intake in each dose of RELYVRIO and monitor appropriately.

CONTRAINDICATIONS
None.

ADVERSE REACTIONS
The most common adverse reactions (at least 15% and at least 5% greater than placebo) with RELYVRIO were diarrhea, abdominal pain, nausea, and upper respiratory tract infection. Gastrointestinal-related adverse reactions occurred throughout the study but were more frequent during the first 3 weeks of treatment.

You may report side effects to FDA at 1-800-FDA-1088.

INDICATION

RELYVRIO is indicated for the treatment of amyotrophic lateral sclerosis (ALS) in adults.

For more information about RELYVRIO, please see the full Prescribing Information.

Are you a healthcare professional?

We can provide you with educational resources and the RELYVRIO Enrollment Form to get your patients started on RELYVRIO and enrolled in the ACT Support Program.

Learn More

Talk to your patients about enrolling in ACT

Let them know they will receive personalized support as they start and continue on RELYVRIO.

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS
Risk in Patients With Enterohepatic Circulation Disorders, Pancreatic Disorders, or Intestinal Disorders
RELYVRIO contains taurursodiol, which is a bile acid. In patients with disorders that interfere with bile acid circulation, there may be an increased risk for worsening diarrhea, and patients should be monitored appropriately for this adverse reaction. Pancreatic insufficiency, intestinal malabsorption, or intestinal diseases that may alter the concentration of bile acids may also lead to decreased absorption of either of the components of RELYVRIO. Because different enterohepatic circulation, pancreatic, and intestinal disorders have varying degrees of severity, consider consulting with a specialist. Patients with disorders of enterohepatic circulation (eg, biliary infection, active cholecystitis), severe pancreatic disorders (eg, pancreatitis), and intestinal disorders that may alter concentrations of bile acids (eg, ileal resection, regional ileitis) were excluded from the study; therefore, there is no clinical experience in these conditions.
Use in Patients Sensitive to High Sodium Intake
RELYVRIO has a high salt content. Each initial daily dosage of 1 packet contains 464 mg of sodium; each maintenance dosage of 2 packets daily contains 928 mg of sodium. In patients sensitive to salt intake (eg, those with heart failure, hypertension, or renal impairment), consider the amount of daily sodium intake in each dose of RELYVRIO and monitor appropriately.

CONTRAINDICATIONS
None.

ADVERSE REACTIONS
The most common adverse reactions (at least 15% and at least 5% greater than placebo) with RELYVRIO were diarrhea, abdominal pain, nausea, and upper respiratory tract infection. Gastrointestinal-related adverse reactions occurred throughout the study but were more frequent during the first 3 weeks of treatment.

You may report side effects to FDA at 1-800-FDA-1088.

INDICATION

RELYVRIO is indicated for the treatment of amyotrophic lateral sclerosis (ALS) in adults.

For more information about RELYVRIO, please see the full Prescribing Information.

Reference: 1. RELYVRIO. Package insert. Amylyx Pharmaceuticals Inc; 2022.