Important Safety Information

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.

By submitting this form, I understand I am giving Xeris Pharmaceuticals, Inc., its affiliates, and business partners permission to use the personal information provided in this registration form to contact me by the following methods, but not limited to: mail, email, telephone call or in-person about disease and product information, disease or product-related events, support services, market research, and to share promotional and marketing information. By submitting this form, I consent to these uses and am confirming that I have read and agree to the Xeris Pharmaceuticals® Terms of Use and Privacy Statement. I understand I can unsubscribe by clicking on the unsubscribe link in future communications or by sending a letter with my full contact information (eg, name, address, email, phone, etc) to Xeris CareConnection™ Patient Support Services, 1375 W Fulton Street, Suite 1300, Chicago, IL 60607.

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