Jesse, a patient living with gMG, has received compensationfrom Alexion Pharmaceuticals, Inc.
It is not known if ULTOMIRIS® is safe and effective for the treatment of gMG in children.
Start your adult patients with anti-AChR antibody-positive gMG on ULTOMIRIS® (ravulizumab-cwvz)
Provide a prescription for ULTOMIRIS, order the meningococcal vaccination series, and enroll your patient in support services, all in one place.
- Submitting the form begins OneSource™ enrollment. Once enrollment is complete, OneSource is available to assist with all additional steps
- Submitting online can streamline the onboarding process, but the form can also be submitted via fax or email. Email the completed form to OneSource@Alexion.com or fax to 1-800-420-5150
- Encourage patients to assess their gMG symptoms before treatment, and at regular intervals during treatment, to track their symptoms over time
- Note that the MGFA classification and MG-ADL total score are required for each patient for Step 6 of the Prescriber Start Form
AChR, acetylcholine receptor; gMG, generalized myasthenia gravis; MG-ADL, Myasthenia Gravis Activities of Daily Living; MGFA, Myasthenia Gravis Foundation of America.
Watch an Expert Discuss Initiating ULTOMIRIS
In this video, you’ll learn how to initiate patients on ULTOMIRIS with the Prescriber Start Form and enroll patients into OneSource for ongoing support.
- Due to the risk of serious meningococcal infections, ULTOMIRIS is only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS)1
- Enrollment in the REMS program and additional information on the requirements are available at UltSolREMS.com or by calling 1-888-765-4747
- OneSource can help arrange meningococcal vaccinations before starting treatment
- Have patients complete or update vaccinations for meningococcal bacteria (serogroups A, C, W, Y, and B) according to ACIP guidelines at least 2 weeks prior to initiating ULTOMIRIS1
- Depending on insurance, infusions may occur at a healthcare professional’s office, an infusion center, or in the patient’s home
- Locate an infusion center convenient for your patients, or contact OneSource for live assistance
AChR, acetylcholine receptor; ACIP, Advisory Committee on Immunization Practices; gMG, generalized myasthenia gravis.
OneSource™ CoPay Assistance
The Alexion OneSource CoPay Program provides financial assistance by covering eligible patients’ out-of-pocket medication and infusion costs associated with ULTOMIRIS.
Please refer to the full Terms and Conditions for additional eligibility requirements.
Help with reimbursement
- A majority of commercially insured and Medicare gMG patients have coverage for ULTOMIRIS, but restrictions may vary per region
- Contact your Field Reimbursement Manager (FRM) for assistance in reviewing your local payer policies
OneSource™ CoPay Assistance
Please refer to the full Terms and Conditions for additional eligibility requirements.