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Forms and Documents

Below, you can find materials about Alnylam Assist™ and AMVUTTRA® (vutrisiran). If you have any questions, call Alnylam Assist™ at 1-833-256-2748 (Monday - Friday, 8am - 6pm). 

Sample Letter of Medical Necessity

Sample Letter of Medical Necessity ›

This sample letter template is provided for informational purposes only. It provides an example of the form and types of information that may be provided when responding to a request from a patient’s insurance company to provide supporting clinical documentation or a letter of medical necessity for AMVUTTRA. Use of the information in this letter does not guarantee that the health plan will provide reimbursement for AMVUTTRA and is not intended to be a substitute for or to influence the independent medical judgment of the physician.

Who makes up the Alnylam Assist™ team?

The Alnylam Assist™ team consists of a Case Manager, a Field Reimbursement Director (FRD), and a Patient Education Liaison (PEL). Find out more about the Alnylam Assist™ team ›

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Frequently Asked Questions ›

Enrolling Your Patients

Together with your patient
(in office)

Alnylam Assist® electronic Start Form icon

Electronic Start Form

Begin Here ›


Alnylam Assist® Start Form - To Print And Fax

& Fax

Download Form ›

Initiate then send to patient
(via email)

Alnylam Assist® Start Form - To Email To Patient

DocuSign eSignature

Begin Here ›

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Reduced Serum Vitamin A Levels and Recommended Supplementation
AMVUTTRA® (vutrisiran) treatment leads to a decrease in serum vitamin A levels.

Supplementation at the recommended daily allowance (RDA) of vitamin A is advised for patients taking AMVUTTRA. Higher doses than the RDA should not be given to try to achieve normal serum vitamin A levels during treatment with AMVUTTRA, as serum vitamin A levels do not reflect the total vitamin A in the body.

Patients should be referred to an ophthalmologist if they develop ocular symptoms suggestive of vitamin A deficiency (e.g., night blindness).

Adverse Reactions
The most common adverse reactions that occurred in patients treated with AMVUTTRA were arthralgia (11%), dyspnea (7%), and vitamin A decreased (7%).


AMVUTTRA® (vutrisiran) is indicated for the treatment of the polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults.

For additional information about AMVUTTRA, please see the full Prescribing Information.