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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 financial assistance options for eligible patients, including:
    • $0 Co-Pay Program for commercially insured patients*
    • Interim Access Program that helps patients receive up to 2 months of RELYVRIO while they wait for approval from their insurance company
    • Patient Assistance Program, which may be able to provide assistance for patients who do not have insurance or are unable to pay for treatment
  • 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.

Kaci, ACT Care Coordinator
Kaci

ACT Care Coordinator

*Out-of-pocket costs related to medication, appointments, evaluations, testing, or other related services are not covered by the RELYVRIO Co-Pay Program. The RELYVRIO Co-Pay Program is not available for prescriptions purchased under Medicare, Medicaid, TRICARE, or other federal- and state-funded programs. Amylyx reserves the right to amend or terminate the Program at any time without notice. Co-pay amounts after applying co-pay assistance may depend on the patient’s insurance plan and may vary. The RELYVRIO Co-Pay Program is intended to help patients afford RELYVRIO.

Resources

Download the RELYVRIO Enrollment Form PDF

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 tips on how to complete the RELYVRIO Enrollment Form and get your patients started.

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 ACT Support Program HCP Brochure

ACT Support Program HCP Brochure

Learn more about how ACT works with you to support patients.

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.