All healthcare providers who prescribe ZILBRYSQ must be certified in the REMS.

1 - Review

2 - Agree

3 - Submit

1 - Review

Review the ZILBRYSQ REMS materials:

2 - Agree

Agree to:

Assess the patient for unresolved meningococcal infection.
Assess the patient’s meningococcal vaccine status (MenACWY and MenB).
Vaccinate the patient if needed according to the current Advisory Committee on Immunization Practices recommendations.

3 - Submit

Submit the completed Prescriber Enrollment Form by either:

Agree to counsel patients and provide them with the:

Or - Print and fax, or email to ZILBRYSQ REMS:

US-P-ZL-MG-2200008