Getting Patients Started on RELiZORB is Easy

From ordering, to setup, to patient assistance, getting your patients started on RELiZORB is easy with the information and instructions you’ll find below.

Forms & Ordering

What’s needed to enroll patients?

Two documents are required in order for a patient to be eligible to receive RELiZORB: the Patient Enrollment Form and the Patient Authorization Form.

You and your patient (or their representative) can work together to complete the required forms; just follow these 3 easy steps:

  1. Ask your patient (or their representative) to complete the Patient Authorization Form and sections 1 and 2 of the Patient Enrollment Form
  2. You complete sections 3 through 6 of the Patient Enrollment Form
  3. Submit both completed forms to RELiZORB Support Services by either emailing them to info@relizorbsupport.com or by faxing them to 1-844-233-3146

A copy of each form can be found below:

Please see below for links to sample Letters of Medical Necessity to request approval for use of and subsequent payment for RELiZORB on behalf of your patient. Please note: one form is specific for patients with cystic fibrosis, the other is not. The prescriber must modify the sample letter to be appropriate for the particular patient as the prescriber deems appropriate in his or her professional discretion.

If you have a patient(s) that has been denied coverage for RELiZORB by their insurance company, you may find the “Common Payer Questions and Objections to Covering RELiZORB” document below useful. The document is intended to provide Physicians, Registered Dieticians, and other HCPs who treat patients, that may benefit from the inclusion of RELiZORB as part of an enteral nutrition regimen, with possible responses to questions and objections frequently expressed by insurers/payers in deciding whether to cover RELiZORB. This document is provided for informational purposes only and its use does not guarantee that reimbursement for RELiZORB for a particular patient will be obtained. This document is intended for use with insurers/payers only.

Information for Hospitals

ORDERING IS EASY

For hospitals ordering RELiZORB, refer to the information below.

RELiZORB is supplied in boxes of 30 cartridges: 1 box = 30 cartridges.

The RELiZORB NDC* is 62205000020, and the UDI is 00862205000243.

Distributor/GPO Product/Contract Number
AmerisourceBergen 10177832
Cardinal (Drug Side) 5206982
Cardinal (Medical/Surgical Side) 100295
McKesson 3507662
Medline Industries LCR2205000020
Morris & Dickson 245555
Intalere/GPO VH11821
Premier/GPO PPPH21ALR01
Vizient/GPO MS5910

*Third-party-derived code based on UDI.

To order RELiZORB directly from Alcresta Therapeutics, please send your PO to the following email: GMB-SPS-ALCRESTA@cordlogistics.com. GPOs we currently contract with include Vizient, Intalere, and Premier. For pricing information outside those GPOs, or other hospital ordering related questions, please contact Hospital Order Support at 1-844-632-9271.

HCPCS BILLING CODE

Effective January 1, 2019, RELiZORB has a permanent, separately billable Medicare billing code (B4105). In addition, RELiZORB was assigned the PE04 (Enteral Equipment and/or Supplies) Product and Service Code, which may be relevant for certain patients under the July 11, 1984, Medicare National Coverage Determination for Enteral and Parenteral Nutritional Therapy (180.2).

Additional resources you may find helpful for implementing RELiZORB into your hospital:

Compatible Formulas & Pumps

Click to view formulas and pumps that have been evaluated for use with RELiZORB in both the single and tandem configurations.

RELiZORB Setup Procedure and Use

Single RELiZORB

View a patient-friendly video to understand how to connect and use RELiZORB.

How to Connect and Use RELiZORB

Patients and patient caregivers should review the following RELiZORB installation instructions before use.

  1. Set up the pump and enteral feeding pump tubing set per the pump manufacturer’s instructions. Prime the enteral feeding pump tubing per the manufacturer’s instructions.
  2. Remove the RELiZORB pouch from its carton. Examine the RELiZORB pouch.

    Do not use the RELiZORB if:

    • the pouch seal is broken
    • the current date is past the expiration date shown on the pouch
  3. Remove the RELiZORB from its pouch. Examine the RELiZORB.

    Do not use the RELiZORB if:

    • the RELiZORB is damaged
    • the RELiZORB has been previously used
  4. Secure the RELiZORB to the end of the enteral feeding pump tubing set by inserting the outlet fitting from the pump tubing into the inlet of the RELiZORB with a twisting motion until secure.

FIGURE 1: Securing RELiZORB inlet to outlet fitting from pump tubing.

This illustration shows how to secure the RELiZORB inlet to the outlet fitting from pump tubing.

NOTE: Do not overtighten the enteral feeding pump tubing set fitting when connecting to RELiZORB. A small gap between the flange on the pump tube fitting and the RELiZORB is normal.

  1. Follow the pump manufacturer’s instructions to prime the feeding formula through to the outlet of the RELiZORB.
  2. Connect the RELiZORB outlet fitting to the inlet fitting of the patient extension set or enteral feeding tube that connects to the patient.

FIGURE 2: Connecting RELiZORB outlet to inlet fitting of patient extension set or enteral feeding tube that connects to patient.

This illustration explains how to connect the RELiZORB outlet to the inlet fitting of the patient extension set or the enteral feeding tube that connects to the patient.

  1. If a patient extension set is being used, follow the pump manufacturer’s instructions to prime the feeding formula to the end of the patient extension set.
  2. Set the pump to the prescribed flow rate between 24 and 120 mL/hr and proceed with feeding.

WARNING: If medications, saline flushes or other non-enteral formula materials are to be added, they must be introduced AFTER RELiZORB (i.e. between RELiZORB and the patient). They may be added to the side-port of a Y-connector extension set located between the RELiZORB and the patient as shown below.

FIGURE 3: Medications may be added between RELiZORB and patient.

This image shows how medications can be added between RELiZORB and the patient.

NOTE: If medications or flush solutions are added BEFORE the RELiZORB cartridge, then RELiZORB, all tubing and formula must be discarded. You may re-start feeding using a new RELiZORB and patient extension set. Please follow Steps 1-7 above to re-start the process.

NOTE: If a second RELiZORB is required to be installed to replace an existing RELiZORB, use the following steps:

  • Pause the pump following the pump manufacturer’s instructions
  • Disconnect the current RELiZORB from the patient extension set or enteral feeding tube
  • Remove the current RELiZORB from the enteral feeding pump tubing set
  • Connect the new RELiZORB to the enteral feeding pump tubing set following Step 4 above
  • Prime the enteral formula through to the end of the RELiZORB following Step 5 above
  • Connect the new RELiZORB to the patient extension set or enteral feeding tube following Step 6 above
  • Follow Step 7 above if a patient extension set is being used
  • Follow Step 8 above to re-start enteral formula delivery

Tandem RELiZORB Setup Procedure and Use

For enteral tube feeding formula volumes greater than 500 mL and up to 1000 mL, you can follow the Instructions for Use using one cartridge per 500 mL, or connect two RELiZORBs together in a tandem configuration. The Tandem configuration (two cartridges) is limited to one such use per day. Tandem RELiZORB may also be referred to as “piggy backing.”

Tandem RELiZORB was evaluated with a pump flow rate of 120 mL/hr to run 1000 mL of formula. Some enteral tube feeding formulas may exhibit slower flow rates with Tandem RELiZORB at volumes greater than 500 mL.

For complete product use information, please see the Instructions for Use and Patient Guide.

  1. Set up the pump and feed set per the pump manufacturer’s instructions. Prime the feed set per the manufacturer’s instructions.
  2. Remove two RELiZORB cartridges from their pouches. Examine each RELiZORB. Do not use a RELiZORB cartridge if:
    • the pouch seal is broken
    • the RELiZORB cartridge is damaged
    • the RELiZORB cartridge has been previously used
  3. Join the two RELiZORB cartridges by inserting the outlet fitting from the first RELiZORB into the inlet of the second RELiZORB with a twisting and pushing motion until secure as shown in Figure 1.

    FIGURE 1. Connecting two RELiZORB cartridges together to form a tandem RELiZORB.

  4. Secure the tandem RELiZORB to the end of the feed set tubing by inserting the outlet fitting from the pump tubing into the inlet of the tandem RELiZORB with a twisting and pushing motion until secure as shown below in Figure 2.

    FIGURE 2. Securing tandem RELiZORB inlet to outlet fitting from pump tubing.

  5. Follow the pump manufacturer’s instructions to prime the feeding formula through both cartridges to the outlet of the tandem RELiZORB.
  6. Connect the tandem RELiZORB outlet fitting to the inlet fitting of the pump extension set that connects to the patient as shown in Figure 3.

    FIGURE 3. Connecting tandem RELiZORB outlet to inlet fitting of tube that connects to patient.

  7. Follow the pump manufacturer’s instructions to prime the feeding formula to the end of the pump extension set.

    WARNING: If medications, saline flushes or other non-enteral formula materials are to be added, they must be introduced AFTER the tandem RELiZORB (i.e. between tandem RELiZORB and the patient). They may be added to the side-port of a Y-connector extension set located between the tandem RELiZORB and the patient as shown below in Figure 4.

    FIGURE 4. Medications may be added between the tandem RELiZORB and patient.

NOTE: If medications or flush solutions are added BEFORE the tandem RELiZORB, then both RELiZORB cartridges, all tubing and formula must be discarded.

ENFit Compatibility

RELiZORB is now compatible with ENFit — the new standard in enteral connectors.

RELiZORB is a first-of-its-kind digestive enzyme cartridge designed to hydrolyze available fats in enteral formulas — immediately prior to ingestion.

ENFit is the new ISO 80369-3 standard for enteral connectors designed to help reduce the risk of enteral feeding misconnections and improve patient safety. The ENFit connector helps ensure that connectors do not connect to ports other than ENFit compatible enteral feeding connectors.

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