Wakix prescription referral form 2025

See details

4.9 out of 5

21 votes

The WAKIX® Prescription Referral Form is a document used for prescribing the medication WAKIX (pitolisant) for patients with narcolepsy. It includes sections for patient information, insurance details, prescriber information, diagnosis, prescription specifics, and patient consent for sharing health information with Harmony Biosciences. The form emphasizes the need for complete and accurate information to avoid processing delays and outlines the authorization required from both the prescriber and the patient.

Here's how it works

01. Edit your wakix enrollment form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send wakix prescription form via email, link, or fax. You can also download it, export it or print it out.

The fastest way to redact Wakix prescription referral form online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is the greatest editor for updating your documents online. Adhere to this simple instruction to edit Wakix prescription referral form in PDF format online at no cost:

Sign up and log in. Create a free account, set a strong password, and go through email verification to start managing your forms.
Upload a document. Click on New Document and choose the file importing option: add Wakix prescription referral form from your device, the cloud, or a secure URL.
Make adjustments to the sample. Take advantage of the upper and left-side panel tools to redact Wakix prescription referral form. Add and customize text, images, and fillable fields, whiteout unnecessary details, highlight the significant ones, and comment on your updates.
Get your documentation completed. Send the form to other parties via email, create a link for faster document sharing, export the sample to the cloud, or save it on your device in the current version or with Audit Trail included.

Try all the advantages of our editor right now!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How can I eSign my [KEY] in Word?

Microsoft Word doesn’t have signing tools to create valid eSignatures and enforceable documents. Luckily, DocHub is an online eSignature-compliant editor that supports various file formats, including .doc files. Log in to your account and import the Word version of your [KEY] from your device and cloud, or URL - our editor will automatically turn it into an editable PDF. Make all required alterations in your form and click Sign to create your own legally-binding electronic signature. You will find four signing options from which to choose.

How do you create an e-signature for the [KEY] on iOS?

In addition to a comprehensive toolset for editing PDFs on mobile phones, DocHub enables you to sign your [KEY] along the way. Open our editor in your web browser, make changes using DocHub’s toolset, and complete your editing by eSigning the completed form.

How do you get Wakix?

To get your patients started Complete the WAKIX Prescription Referral Form. The diagnosis (ICD-10) codes for narcolepsy are included on the prescription referral form: ... Fax the completed form to WAKIX for You at 1-855-635-8520. WAKIX for You will contact your patient directly to help him or her get started with WAKIX.

Can you take Wakix and ?

No interactions were found between and Wakix. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Is Wakix a specialty drug?

WAKIX prescriptions are filled through a Specialty Pharmacy, which may be different than how you've received other prescription medications. WAKIX for You helps facilitate interactions between you, your healthcare provider's office, the insurance plan, and the Specialty Pharmacy.

wakix prescription referral form

WAKIX patient assistance program WAKIX Prescribing Information XYWAV Prescription Form WAKIX for you phone number XYREM Prescription Form WAKIX Pharmacy WAKIX Pharmacy phone number Wakix cost

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

How do you get a prescription on Wakix?

Prescribing WAKIX Complete the WAKIX Prescription Referral Form. The diagnosis (ICD-10) codes for narcolepsy are included on the prescription referral form: G47. ... Fax the completed form to WAKIX for You at 1-855-635-8520. WAKIX for You will contact your patient directly to help him or her get started with WAKIX.

What is Wakix prescribed for?

Full Prescribing Information. WAKIX is indicated for the treatment of excessive daytime sleepiness (EDS) or cataplexy in adult patients with narcolepsy. WAKIX is contraindicated in patients with known hypersensitivity to pitolisant or any component of the formulation and in patients with severe hepatic impairment.

Can you take Wakix with ?

No interactions were found between and Wakix. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

How much does Wakix cost per month?

Wakix Coupon & Prices - Cost $49 per month.

What is Wakix used to treat?

WAKIX is a first-of-its-kind medication that increases histamine levels in the brain. WAKIX is the first and only once-daily tablet that is FDA approved to treat EDS or cataplexy in adults with narcolepsy. WAKIX is the first and only FDA-approved treatment for people with narcolepsy that is not a controlled substance.

Wakix prescription referral form 2025

Here's how it works

The fastest way to redact Wakix prescription referral form online

Complete this form in 5 minutes or less

Got questions?

How can I eSign my [KEY] in Word?

How do you create an e-signature for the [KEY] on iOS?

How do you get Wakix?

Can you take Wakix and ?

Is Wakix a specialty drug?

Complete this form in 5 minutes or less

People also ask

How do you get a prescription on Wakix?

What is Wakix prescribed for?

Can you take Wakix with ?

How much does Wakix cost per month?

What is Wakix used to treat?

wakix form

Try more PDF tools