How to Help Your Patients Find Glutamine (Endari) in Stock: A Provider's Guide

You've prescribed Glutamine (Endari or generic L-glutamine oral powder) for your patient with sickle cell disease. But writing the prescription is only step one. Given the access barriers associated with this specialty medication — prior authorization requirements, specialty-only dispensing, high out-of-pocket costs, and limited pharmacy availability — many patients never successfully fill their prescription.

This guide provides a practical framework for providers to proactively help patients navigate these barriers and actually get their medication in hand.

Understand the Access Landscape Before You Prescribe

Glutamine is a specialty medication dispensed exclusively through specialty pharmacies. Standard retail chains (CVS, Walgreens, Rite Aid) do not carry it at their standard pharmacy counters. This means your patient will need to be connected to a specialty pharmacy that participates in the Endari distribution network.

Real-world data from Montefiore Medical Center shows that after 10 months, only 21% of patients prescribed L-glutamine were actively taking it. 33% never filled the prescription. Your team's involvement in pharmacy navigation and PA submission dramatically improves these odds.

Step 1: Submit Prior Authorization Proactively — At the Time of Prescribing

Don't wait for a prior authorization denial before initiating the process. Most commercial and Medicare plans require PA for Glutamine, and the review process takes days to weeks. Common PA requirements include:

Confirmed diagnosis of sickle cell disease (ICD-10: D57.x)

Documentation of current or prior hydroxyurea use OR contraindication/intolerance

History of VOC frequency and severity in the past 12 months

Intended dose per body weight (0.3 g/kg BID, maximum 30 g/day)

Tip: Designate a care coordinator or nurse navigator to manage PA submissions for SCD patients. This reduces the burden on providers and speeds up the process.

Step 2: Send the Prescription to the Right Pharmacy

Coordinate with your team to send the prescription directly to a specialty pharmacy in the Endari network — do not rely on the patient to navigate this themselves. Options include:

TheraCom Specialty Pharmacy — Emmaus' designated partner for the Endari Support Program

CVS Specialty, Walgreens Specialty, Optum Rx — Carry Endari with home delivery options

Amazon Pharmacy — Accepts transfers with free delivery for Prime members

For patients in areas without convenient specialty pharmacy access, mail-order delivery is the most reliable option and is often preferred by insurance plans.

Step 3: Connect Patients With Financial Assistance Programs

Even with insurance, the cost of Glutamine can be a significant barrier. Emmaus Medical offers two programs:

Commercial Copay Assistance Program: For commercially insured patients. Eligible patients pay as little as $10/month. Patients must not be on Medicare or Medicaid. Apply at endarirx.com/copay-assistance or call 855-723-5646.

Endari Support Program: For uninsured or underinsured patients. Provides minimal or no-cost medication. Call 1-855-723-5646 or visit endarirx.com/esp.

Additional financial assistance for SCD patients may be available through the Sickle Cell Disease Association of America, HealthWell Foundation (when open), and Patient Advocate Foundation.

Step 4: Use medfinder to Locate Available Pharmacies

For patients who need help locating a pharmacy that currently has Glutamine in stock, medfinder for providers is a service that calls pharmacies on behalf of patients to check real-time availability. This removes the burden from patients who might otherwise call dozens of pharmacies themselves, increasing the likelihood they actually fill their prescription.

Step 5: Set Realistic Expectations for Patients About Adherence

Glutamine requires twice-daily dosing, with each dose mixed fresh in a liquid or soft food immediately before taking. This regimen requires planning and consistency. Patients should be counseled:

Glutamine must be mixed fresh — do not prepare doses in advance

Do NOT mix with hot food or liquid — this may degrade the medication

Store packets at room temperature, away from direct sunlight, in original foil pouches

Missing doses reduces the therapeutic benefit — consistent twice-daily use is important

Provider Checklist for Glutamine Prescription Workflow

Verify insurance type and prior auth requirements before prescribing

Submit PA with SCD diagnosis, VOC history, and hydroxyurea documentation at the time of prescribing

Send prescription directly to an Endari network specialty pharmacy

Enroll eligible patients in Emmaus copay assistance or support program

Follow up at next visit to confirm prescription was filled and patient is taking it correctly

Share medfinder.com with patients as a pharmacy search tool

For more provider resources, visit medfinder for providers or read our provider's guide to Glutamine savings programs.