Product information and disease descriptionProduct descriptionProduct information
Access and distribution
9 evidence topics · 4 sources
Specialty pharmacy: PANTHERx Rare
Patient support program: Egetis RareLink
QuickStart, Bridge, patient assistance, and copay programs
Prescription requirements
| Form item | Form text |
|---|---|
| Prescriber attestation | “Prescriber Attestation: I confirm that the patient has been diagnosed with MCT8 deficiency.” |
| Genetic confirmation | “Genetic test result for a mutation in SLC16A2” |
| Copy of genetic test | “Copy of genetic test result included” |
| Baseline thyroid function | “Baseline serum T3 (include units of measurement and date of result)” |
| Prior thyromimetic therapy | “Has the patient ever received DITPA (3,5-diiodothyropropionic acid)?” |
| Prior tiratricol exposure | “Did the patient take EMCITATE® as part of the EAP or clinical trial?” |
| Body weight | “Weight (kg)” |