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Forms & Resources
Alnylam Assist® provides you and your patients with helpful forms and educational resources throughout the treatment journey.
OXLUMO® (lumasiran) Start Form
Find 3 different options to get your patients started.
Together with Your Patient
(in Office)
OR
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Print, complete with your patients, and fax the Start Form 1-833-256-2747.
Initiate then Send to Patient (via Email)
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Fill out the sections of the Start Form. It will be emailed, via DocuSign, to the patient to complete.
Available in Other Languages
OXLUMO Resources
Find informational resources for the treatment journey.
OXLUMO Coverage, Coding, and Reimbursement
Sample Letter of Medical Necessity
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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 OXLUMO. Use of the information in this letter does not guarantee that the health plan will provide reimbursement for OXLUMO and is not intended to be a substitute for or to influence the independent medical judgment of the physician
OXLUMO Resources for Patients & Caregivers
OXLUMO Dosing and Prescribing Information
Alnylam Assist® Program Resources
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Find resources for patients, caregivers, and healthcare professionals.
Have Questions?
Alnylam Case Managers
are here to help your patients
with an Alnylam product.
If you or your office staff have questions,
call us at:
1-833-256-2748
Monday–Friday, 8am–6pm
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