A patient support program that offers a range of services for your patients prescribed XOLREMDI™ (mavorixafor)
Prescribe XOLREMDI and enroll your patient in 3 steps:
1
Download and complete the enrollment form for your patient.
2
Invite your patient to review and sign the consent to receive services from X4Connect.
3
Fax the form, with required documentation, to 877.914.0598.
Prescribing XOLREMDI
XOLREMDI is available through PANTHERx, our exclusive specialty pharmacy partner.
When you complete the X4Connect Enrollment Form, PANTHERx will verify coverage, and once approved, XOLREMDI will be shipped directly to your patient.
Dedicated Team
Once enrolled in X4Connect, your patient will have a dedicated team throughout their treatment journey.
X4Connect Care Coordinators
Investigate insurance coverage and help navigate prior authorizations, appeals, and financial support options.
X4Connect Specialty Pharmacists
Counsel patients on XOLREMDI treatment.
X4 Nurse Educators
Provide education and resources about XOLREMDI and WHIM syndrome to patients and their caregivers.*
*X4 Nurse Educators are employees of X4 Pharmaceuticals and do not work under the direction of a healthcare professional; they do not offer medical or treatment-related advice. For treatment and medical questions, patients should contact their healthcare provider.
Financial Assistance Programs
For eligible patients we provide†:
- Copay Assistance: Helps patients with commercial or private insurance pay as little as $0 for XOLREMDI up to a maximum annual limit.
- Quick Start Program: Helps patients access therapy in the event of an insurance-related delay.
- Bridge Program: Helps patients continue to receive therapy in the event of an insurance coverage interruption.
- Patient Assistance Program: Helps patients who are uninsured or underinsured obtain access to XOLREMDI at no cost.
†Terms and conditions apply to all financial support options. X4 reserves the right to modify or discontinue these programs at any time. Full terms and conditions provided prior to enrollment.
Call X4Connect
844-X4CNNCT
(844.942.6628)
M–F, 8am–8pm ET
Additional Resources
X4Connect Enrollment Form
Initiate your patient’s XOLREMDI prescription and invite your patient to enroll in X4Connect.
X4Connect HCP Guide
X4Connect program overview and quick reference for getting your patient started on XOLREMDI.
Letter of Medical Necessity Template
Customizable sample letter that may help you with the prior authorization process for XOLREMDI.
Letter of Appeal Template
Customizable sample letter for use, if necessary, during the appeals process for XOLREMDI.
IMPORTANT SAFETY INFORMATION
CONTRAINDICATION
XOLREMDI is contraindicated with drugs highly dependent on CYP2D6 for clearance.
WARNINGS AND PRECAUTIONS
Embryo-Fetal Toxicity: Based on its mechanism of action, XOLREMDI is expected to cause fetal harm. Verify pregnancy status of female patients of reproductive potential prior to starting XOLREMDI. Advise females of reproductive potential to use effective contraception during treatment with XOLREMDI and for three weeks after the final dose.
QTc Interval Prolongation: XOLREMDI causes concentration-dependent QTc prolongation. Correct any modifiable risk factors for QTc prolongation, assess QTc at baseline, and monitor QTc during treatment as clinically indicated in patients with risk factors for QTc prolongation or receiving concomitant medications that increase XOLREMDI exposure and/or drugs with a known potential to prolong the QTc interval. Dose reduction or discontinuation of XOLREMDI may be required.
ADVERSE REACTIONS
The most common adverse reactions (in ≥10% patients and more frequently reported than placebo) were thrombocytopenia, pityriasis, rash, rhinitis, epistaxis, vomiting, and dizziness.
DRUG-DRUG INTERACTIONS
Avoid co-administration of XOLREMDI and strong CYP3A4 inducers. Reduce XOLREMDI daily dosage when administered with strong CYP3A4 inhibitors. Monitor more frequently for adverse reactions associated with an increase in exposure of XOLREMDI when used concomitantly with moderate CYP3A4 inhibitors or P-gp inhibitors and reduce XOLREMDI daily dosage if necessary.
USE IN SPECIFIC POPULATIONS
Advise females that breastfeeding is not recommended during treatment with XOLREMDI and for three weeks after the final dose.
The safety and effectiveness of XOLREMDI have not been established in pediatric patients younger than 12 years of age.
XOLREMDI is not recommended in patients with severe renal impairment, end-stage renal disease, or moderate to severe hepatic impairment.
To report suspected adverse reactions, contact X4 Pharmaceuticals at 1-866-MED-X4MI (1-866-633-9464) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
INDICATION
XOLREMDI™ (mavorixafor) is a CXC chemokine receptor 4 (CXCR4) antagonist indicated in patients 12 years of age and older with WHIM syndrome (warts, hypogammaglobulinemia, infections and myelokathexis) to increase the number of circulating mature neutrophils and lymphocytes.
Please see the full Prescribing Information for XOLREMDI.
IMPORTANT SAFETY INFORMATION
CONTRAINDICATION
XOLREMDI is contraindicated with drugs highly dependent on CYP2D6 for clearance.
WARNINGS AND PRECAUTIONS
Embryo-Fetal Toxicity: Based on its mechanism of action, XOLREMDI is expected to cause fetal harm. Verify pregnancy status of female patients of reproductive potential prior to starting XOLREMDI. Advise females of reproductive potential to use effective contraception during treatment with XOLREMDI and for three weeks after the final dose.
QTc Interval Prolongation: XOLREMDI causes concentration-dependent QTc prolongation. Correct any modifiable risk factors for QTc prolongation, assess QTc at baseline, and monitor QTc during treatment as clinically indicated in patients with risk factors for QTc prolongation or receiving concomitant medications that increase XOLREMDI exposure and/or drugs with a known potential to prolong the QTc interval. Dose reduction or discontinuation of XOLREMDI may be required.
ADVERSE REACTIONS
The most common adverse reactions (in ≥10% patients and more frequently reported than placebo) were thrombocytopenia, pityriasis, rash, rhinitis, epistaxis, vomiting, and dizziness.
DRUG-DRUG INTERACTIONS
Avoid co-administration of XOLREMDI and strong CYP3A4 inducers. Reduce XOLREMDI daily dosage when administered with strong CYP3A4 inhibitors. Monitor more frequently for adverse reactions associated with an increase in exposure of XOLREMDI when used concomitantly with moderate CYP3A4 inhibitors or P-gp inhibitors and reduce XOLREMDI daily dosage if necessary.
USE IN SPECIFIC POPULATIONS
Advise females that breastfeeding is not recommended during treatment with XOLREMDI and for three weeks after the final dose.
The safety and effectiveness of XOLREMDI have not been established in pediatric patients younger than 12 years of age.
XOLREMDI is not recommended in patients with severe renal impairment, end-stage renal disease, or moderate to severe hepatic impairment.
To report suspected adverse reactions, contact X4 Pharmaceuticals at 1-866-MED-X4MI (1-866-633-9464) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
INDICATION
XOLREMDI™ (mavorixafor) is a CXC chemokine receptor 4 (CXCR4) antagonist indicated in patients 12 years of age and older with WHIM syndrome (warts, hypogammaglobulinemia, infections and myelokathexis) to increase the number of circulating mature neutrophils and lymphocytes.
Please see the full Prescribing Information for XOLREMDI.