Supplemental Information for JYNARQUE® (tolvaptan)
JYNARQUE Prescription Process Checklist
A reminder of the steps to prescribe patients JYNARQUE.
Prescription Referral Form
You can e-prescribe or fax this completed form to one of the Specialty Pharmacies.
Quest Lab Account Setup Form
Set up an account with Quest Lab to facilitate compliance with JYNARQUE Risk Evaluation and Mitigation Strategy (REMS)-required lab work for your patients treated with JYNARQUE.
LabCorp Account Setup Form
Set up an account with Labcorp to facilitate compliance with REMS-required lab work for your patients treated with JYNARQUE.
JYNARQUE REMS Program Patient Status Form
Document the required monitoring for patients treated with JYNARQUE.
JYNARQUE Patient Tracker
Record your patients’ monitoring information.
Patient enrollment form
Sign patients up for the REMS program by completing the healthcare professional section first, then having patients fill out the rest. Submit the form either online at JYNARQUEREMS.com or by printing a paper copy that can be submitted by fax at 1-866-750-6820.
Lab Support Flashcard
Learn more about the Otsuka Laboratory Support Program. The program helps eligible patients get their REMS-required blood work done at no cost through a partnership with LabCorp and Quest Diagnostics.
Looking for more information about JYNARQUE?
To learn more about JYNARQUE and access more treatment resources, go to JYNARQUEhcp.com.
To learn more about the JYNARQUE REMS program or to access patient forms, go to JYNARQUEREMS.com.