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Forms and Documents

Below, you can find materials about Alnylam Assist™ and treatment with OXLUMO® (lumasiran). 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 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.

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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Find answers to other

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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Adverse Reactions
The most common (≥20%) adverse reaction reported in patients treated with OXLUMO was injection site reaction. Injection site reactions included erythema, swelling, pain, hematoma, pruritus, and discoloration.

Pregnancy and Lactation
No data are available on the use of OXLUMO in pregnant women. No data are available on the presence of OXLUMO in human milk or its effects on breastfed infants or milk production. Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for OXLUMO and any potential adverse effects on the breastfed child from OXLUMO or the underlying maternal condition.


OXLUMO® (lumasiran) is indicated for the treatment of primary hyperoxaluria type 1 (PH1) to lower urinary and plasma oxalate levels in children and adults.

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