Help your patient get started on AMVUTTRA® (vutrisiran) by filling out the electronic Start Form together.
The purpose of this form is to permit Alnylam Assist™ participants to receive additional information and support (“Patient Support”) from Alnylam Pharmaceuticals, Inc., its affiliates, representatives, agents, and contractors (“Alnylam”). Alnylam Assist™ provides Patient Support to eligible patients who have been prescribed an Alnylam medicine. This includes: (1) providing reimbursement and financial support to eligible patients (such as investigating your insurance coverage, confirming out-of-pocket costs, and reviewing eligibility for financial assistance); (2) working with you and your provider to fill their prescription; and (3) providing you with disease and medication-related educational resources and communications. Your authorization in this form will relate to information and support with respect to any Alnylam medicine you have been prescribed or may be prescribed in the future.
PLEASE NOTE: Patients and healthcare providers should be together when filling out the Start Form. Consent via electronic signature is mandatory for submission of the form. Forms must be submitted once started, as progress will not be saved. If you are unable to complete the electronic Start Form with your patient, you can begin filling out the form and email it to your patient via DocuSign.
This form is best viewed using the latest version of Chrome, Safari, or Firefox.