Institution Pharmacy

Per FDA requirements, in order to order, stock, and dispense Tikosyn and its authorized generic new pharmacies are required to secure a one-time certification. Even if your institution has been certified prior to 2011, you are required to secure a one-time recertification. You must enroll in the Tikosyn and Authorized Generic REMS program to prescribe or dispense Tikosyn® or its authorized generic. To become (re)certified you must review the following materials:

Tikosyn and Authorized Generic Treatment Guidelines

Prescribing Information

Medication Guide
 

And sign the Institution Certification Form:

NOTE: A designated representative must complete and sign this form as part of the Tikosyn and Authorized Generic REMS Program requirement.

Tikosyn and Authorized Generic Institution Form
 

When you have reviewed all the materials, please print, sign, and mail or fax back the Certification Form. The fax number is 1-800-788-2637. After the Certification Form is received, you will receive written confirmation of receipt. In addition, before dispensing Tikosyn or its authorized generic, you are required to confirm that the prescriber has been certified.

Before dispensing Tikosyn or its authorized generic, the pharmacist is required to confirm that the prescriber has been certified. In addition, the institution must agree to stock and provide patients prior to discharge a free 7-day (14 count) supply of Tikosyn or its authorized generic and the Medication Guide. As a contingency, if the initiating/re-initiating institution does not have outpatient licensing privileges to dispense the free 7-day supply of Tikosyn or its authorized generic, the institution will ensure the patient's take home prescription is ordered and filled at a retail pharmacy prior to patient discharge.

Contact us

Should you have any questions regarding the Tikosyn and Authorized Generic certification, please call 1-866-249-7261.