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Forms & Resources
Alnylam Assist® provides you and your patients with helpful forms and educational resources throughout the treatment journey.
AMVUTTRA® (vutrisiran) Start Form
2 ways to get your patient started.
OR
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Print, complete with your patient,
and fax the Start Form to
1-833-256-2747.
If you are not able to obtain your patient's signature,
an Alnylam Case Manager can follow up
with them to obtain their consent.
Available in Other Languages
AMVUTTRA Resources
Find informational resources for the treatment journey.
AMVUTTRA Coverage, Coding, and Reimbursement
AMVUTTRA 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 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
AMVUTTRA Resources for Patients & Caregivers
AMVUTTRA Dosing and Prescribing Information
Alnylam Assist® Program Resources
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Find resources for patients, caregivers, and healthcare professionals.
