Relyvrio

Indicated For

ALS

About This Medication

# Amylyx Care Team (ACT) Support Program Patient Guide: How to Get RELYVRIO at Low or No Cost ## Important Update: RELYVRIO Market Status As of March 2026, Amylyx Pharmaceuticals has voluntarily discontinued marketing authorizations for RELYVRIO in the U.S. and Canada. The medication is no longer available for new patients. However, patients currently on RELYVRIO who wish to continue treatment can be transitioned to a free drug program through Amylyx. This guide provides information for patients already prescribed RELYVRIO who are seeking to maintain access through patient assistance. ## About RELYVRIO RELYVRIO (sodium phenylbutyrate and taurursodiol) is a prescription oral medication used to treat adults with amyotrophic lateral sclerosis (ALS). The medication is an oral, fixed-dose combination therapy that comes as a powder for oral suspension. Each packet contains 3 grams of sodium phenylbutyrate and 1 gram of taurursodiol, taken as prescribed by your healthcare provider. ## The Amylyx Care Team (ACT) Support Program The ACT Support Program is Amylyx Pharmaceuticals' patient assistance program designed to help eligible patients with ALS who have been prescribed RELYVRIO access their medication. ACT serves as a dedicated support team that works directly with you, your healthcare provider, and your insurance company to facilitate access to RELYVRIO and overcome potential barriers to treatment. ## Who Qualifies for ACT Support To be eligible for the ACT Support Program, you must: - Have a diagnosis of amyotrophic lateral sclerosis (ALS) - Have been prescribed RELYVRIO by your healthcare provider - Be a resident of the United States or Canada - Currently be on RELYVRIO therapy (as new prescriptions are no longer being accepted) Income eligibility thresholds for the ACT program have not been publicly disclosed. However, ACT works with patients across all insurance types, including those with commercial insurance, Medicare, and Medicaid, to determine affordable access options on a case-by-case basis. ## Insurance Requirements and Coverage The ACT Support Program works with all major insurers, including: - Commercial insurance plans - Medicare - Medicaid - State-specific insurance programs Amylyx does not require patients to have insurance to receive support, though having insurance information helps ACT navigate coverage options. For patients with commercial insurance, ACT offers a copay assistance program that can reduce your out-of-pocket costs to $0. For patients on Medicare and/or Medicaid, ACT works with you individually to determine affordable access options. ## Step-by-Step Application Process ### Step 1: Gather Required Information Before starting your application, have the following information ready: - Your ALS diagnosis date - Your most recent ALS treatments - Your current insurance information (insurance company name, member ID, group number) - Your healthcare provider's contact information - Your prescription from your healthcare provider for RELYVRIO ### Step 2: Complete the Enrollment Form The ACT enrollment form is a 2-page document that includes: **Patient Information Section (completed by you):** - Your personal demographics - Your diagnosis date - Your recent treatment history - Your insurance information - Your authorization for Amylyx to work with your insurance company - Your HIPAA authorization for use and disclosure of protected health information **Provider Section (completed by your healthcare provider):** - Your provider's clinical assessment - The RELYVRIO prescription details - Any additional clinical information relevant to your treatment ### Step 3: Submit Your Application You can submit your completed enrollment form through multiple methods: - **Online:** Submit through Amylyx's online enrollment portal - **Fax:** Send to the ACT Support Program at 1-844-283-0375 - **Mail:** Contact ACT for mailing instructions - **Phone:** Call 1-866-318-2989 to request assistance with the application process You can also email completed forms to amylyxcareteam@amylyx.com. ### Step 4: ACT Reviews Your Application Once ACT receives your completed enrollment form, the team will: - Verify your eligibility - Contact your insurance company to determine coverage - Confirm your out-of-pocket costs - Identify available financial assistance options - Contact you with next steps ## Timeline and Delivery **Processing Time:** While specific processing timelines are not publicly detailed, ACT prioritizes rapid enrollment given the progressive nature of ALS. The team works to expedite the process to minimize delays in treatment access. **Interim Access Program:** For commercially insured patients, Amylyx offers an Interim Access Program that provides up to two months of RELYVRIO at no cost while your prescription coverage is being secured. This program helps bridge any gaps between enrollment and insurance approval. **Delivery Method:** Once approved, RELYVRIO is dispensed through specialty pharmacies designated by the ACT Support Program. The medication is shipped directly to you or your healthcare provider. **Free Drug Program for Current Patients:** Patients currently on RELYVRIO who wish to continue treatment can be transitioned to a free drug program, ensuring continued access without cost. ## Financial Assistance Options ACT offers multiple financial assistance programs: - **Copay Assistance Program:** Reduces copay costs to $0 for eligible patients with commercial insurance - **Interim Access Program:** Provides up to two months of free medication for commercially insured patients while coverage is being finalized - **Medicare/Medicaid Support:** ACT works individually with patients on government insurance to determine affordable access options - **Insurance Appeal Support:** If your insurance denies coverage, ACT provides templated appeal letters that your healthcare provider can use ## What If Your Application Is Denied? If your insurance denies coverage for RELYVRIO: 1. **ACT Appeal Support:** ACT will provide your healthcare provider with templated appeal letters to submit to your insurance company 2. **Reapplication:** You can work with ACT to address the reason for denial and reapply 3. **Alternative Assistance:** ACT will explore other financial assistance options, including the free drug program for current patients 4. **Provider Advocacy:** Your healthcare provider can work directly with ACT to advocate for your access to treatment ## Reauthorization and Ongoing Support Once enrolled in the ACT Support Program, you will receive ongoing support for: - **Prescription Refills:** ACT coordinates with your pharmacy and insurance to ensure continuous access to your medication - **Insurance Changes:** If your insurance coverage changes, notify ACT immediately so they can update your coverage information - **Cost Changes:** If your out-of-pocket costs increase, ACT can help identify additional financial assistance options - **Medication Management:** ACT provides support for any questions about your medication or treatment plan ## Contact Information **Amylyx Care Team (ACT) Support Program:** - **Phone:** 1-866-318-2989 - **Fax:** 1-844-283-0375 - **Email:** amylyxcareteam@amylyx.com ACT is available to answer questions about the enrollment process, insurance coverage, financial assistance options, and medication access. ## Important Disclaimer This guide provides general information about the Amylyx Care Team (ACT) Support Program as of March 2026. Program details, eligibility requirements, and financial assistance options may change. RELYVRIO is no longer available for new patients as of March 2026; this information applies only to patients currently on RELYVRIO therapy. Always consult with your healthcare provider and the ACT Support Program directly for the most current and accurate information about your specific situation. This guide is not a substitute for professional medical advice, and you should always follow your healthcare provider's recommendations regarding your ALS treatment.

Program information last verified: March 30, 2026