Prescribers:

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

To become certified, prescribers must:

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:

  • Clicking "Start Online Prescriber Enrollment" below; or
  • Scanning and emailing to ZILBRYSQREMS@ppd.com; or
  • Faxing to 1-877-411-3609

Agree to counsel patients and provide them with the:

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

Prescriber Enrollment Form

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ZILBRYSQ® is a trademark of the UCB Group of Companies.
©2023 UCB, Inc., Smyrna, GA 30080.  All rights reserved.
Intended for residents of the United States only.

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