Request FGF23 Test Kit

Kyowa Kirin Sponsored Hypophosphatemia Program

Through the Kyowa Kirin Sponsored Hypophosphatemia Program, HCP's can provide patients who have met one of the following eligibility criteria access to no-charge biochemical testing for FGF23 levels.

Patient with XLH aged 6 months or older with a Kyowa Kirin Cares Enrollment Form for XLH
Patient with TIO aged 2 years or older with a Kyowa Kirin Cares Enrollment Form for TIO
Patient with TIO aged 2 years or older with phosphaturic mesenchymal tumors that cannot be curatively resected or localized

(*Required fields)

Do you confirm you have a patient that meets the eligibility criteria referenced?* Yes, I would like to request a FGF23 test kit. Not at this time.

Complete this form to request a FGF23 test kit from Mayo Clinic Laboratories. This program is only available for HCPs in the US.

Please click the link to look up your NPI number
https://npiregistry.cms.hhs.gov/search

Email*(Used only for record-keeping purposes)

Mobile Phone number*(Used only for record-keeping purposes)

Kyowa Kirin has collaborated with Mayo Clinic Laboratories to offer sponsored, no-charge testing to patients who are being evaluated for a possible diagnosis of XLH. The Kyowa Kirin Sponsored Hypophosphatemia Program is intended to improve patient safety and quality of care by shortening the time to an accurate diagnosis, facilitate prompt confirmatory testing, and help patients with XLH meet payer coverage requirements. Use of or participation in the Kyowa Kirin Sponsored Hypophosphatemia Program does not create any obligation to use, prescribe, or recommend any Kyowa Kirin products or services. The Program is only available to patients that meet certain eligibility requirements and for whom the patient's health care provider has determined that testing is clinically appropriate. No patient or health care provider may seek reimbursement for testing or counseling services provided under the Kyowa Kirin Sponsored Hypophosphatemia Program from any third party, including but not limited to, any government health care programs.

Thank you for requesting a FGF23 test kit. Your kit will be shipped to the address you provided in the form in 3-5 business days.

If you have any questions, please feel free to contact the KKNA MSL Team at kkna.msl@kyowakirin.com

What’s included in the kit:

(1) Test Request Form
(1) Refrigerate/Ambient 5 lb Shipping Box
(1) 5 lb Styrofoam
(1) Refrigerate Specimen Bag AMC04
(1) Transfer Pipette
(1) Serum Separator Tube (SST) - 3.5 mL
(1) Aliquot Tube
(1) FedEx Return Shipping Label

Next Steps.

1. Fill out the test request form. Complete all fields and set aside.
2. Collect the serum specimen. Using the items provided, collect and prepare the serum specimen for lab analysis
3. Package items and send to Mayo Clinic Laboratories. Using the FedEx Return Shipping Label, send both the prepared specimen and the Test Request Form in the Refrigerate/Ambient 5 lb Shipping Box

Mayo Clinic Laboratories will analyze and fax the test results to the fax number provided on the Test Request Form. Mayo Clinic Laboratories will contact you if they have any questions.