Prescriber Enrollment
Instructions
Healthcare providers who prescribe ambrisentan (prescribers) must be specially certified and enrolled in the PS-Ambrisentan REMS (even if previously enrolled in the Letairis REMS). To become certified, the prescriber must first read the Prescribing Information and the Prescriber Guide, and then agree to follow the PS-Ambrisentan REMS requirements by completing the Prescriber Enrollment and Agreement Form.

Overview of online enrollment:

1
Prescriber Information - Prescribers will enter an individual National Provider Identifier (NPI) number. This will be used to obtain most of the information needed for enrollment. The prescriber will be asked to provide additional information about the best time and way to be contacted.

2
Office Information - The prescriber will be asked to provide information for an additional person in the office that may be contacted.

3
Create Password - The prescriber will be asked to enter a password to create the program account. Upon creation of the account, the prescriber will receive an email with a link. Upon clicking on the link in the email, the prescriber will be asked to log in and complete the enrollment.

4
Agreement - The prescriber will be asked to provide their signature. By signing, the prescriber signifies their understanding of the risks associated with ambrisentan treatment and their obligation as an ambrisentan prescriber to educate female patients about these risks, counsel them on risk reduction, monitor them appropriately, and report adverse events to the REMS Coordinating Center.

5
Complete - The enrollment will be completed upon agreeing and providing a signature.