Start here to prescribe KEVEYIS

Help Primary Periodic Paralysis (PPP) patients gain greater control over their symptoms and attacks.

Starting a patient on KEVEYIS

  • The start form needs to be filled out in its entirety in order to start a patient on KEVEYIS.
  • To receive the benefits of Xeris CareConnection™, “Brand Medically Necessary” must be hand-written on the start form.
  • Submit any patient information or chart notes along with the start form.

Before you fax the start form, please make your patient aware that a KEVEYIS Patient Access Manager will call them to begin the benefits verification process.

Fill out the Prescription Start form

Please fill out the Prescription Start Form in its entirety. Once you have completed it, fax the form to 1-312-276-4846.

KEVEYIS $0 Copay Program

Eligible patients may pay as little as $0 for their prescription.*

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*Eligible patients pay as little as $0 with a maximum annual savings of $10,000. The authorized specialty pharmacy will activate the copay card for eligible patients and apply for each prescription until the annual maximum has been reached. This card is not valid for prescriptions that may be reimbursed under a federal or state healthcare program, including Medicare, Medicaid, or any other similar federal or state healthcare program, including any state pharmacy assistance program. For additional questions about the co-pay program, including eligibility, call Xeris CareConnection™ at 844-KEVEYIS (538‑3947)

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Take the next step

Get customized support for your KEVEYIS journey. Simply fill out the information and a Patient Access Manager will contact you. They will walk you through the entire process, from diagnosis to treatment and beyond.