Your first 90 days
Your first 90 days on Attruby for ATTR amyloidosis with cardiomyopathy
What happens before the first fill, the days that matter, the label's rules and who to call, from the label, the drugmaker's own program and one insurer's written rules.
Attruby has no REMS form, no vaccine and no test the label requires before the first fill. Insurers do want heart imaging and proof of the diagnosis on file. What stands between the prescription and the first dose is mostly paperwork, the insurance approval and a call from a specialty pharmacy. This page lays out the first 3 months from the FDA label, BridgeBio's ForgingBridges program and one insurer's written rules.
What has to happen before the first bottle ships
Attruby is a specialty drug without a REMS, so the first fill waits on an insurance approval and a specialty pharmacy call, not on a safety program form. These are the 6 things in the way, in order.
Proof of the diagnosis, for the insurer
Most plans want the diagnosis confirmed in your records before they agree to pay.
- Cigna's policy accepts a technetium pyrophosphate heart scan, a tissue biopsy typed as TTR amyloid, or a genetic test showing a TTR variant.
- It also wants heart imaging that shows the heart is involved.
- Ask the office which of these is already in your chart.Cigna policy
A word about tafamidis and gene silencers
Cigna's policy will not cover Attruby taken together with tafamidis or with a drug that silences TTR, such as Amvuttra, Onpattro or Wainua.
- The Attruby label itself does not say anything about combining them.
- If you take one of these now, ask the cardiologist what this means for your current treatment.Cigna policy
A medicine review
The label says to avoid medicines that induce UGT enzymes and strong CYP3A inducers, because they can lower Attruby levels.
- Attruby can also raise levels of medicines cleared by the CYP2C9 enzyme.
- The Patient Information asks you to list every prescription, over-the-counter medicine, vitamin and herbal supplement.FDA label
Pregnancy and breastfeeding, raised before day 1
The label says it is not known whether Attruby harms an unborn baby or passes into breast milk.
- The label sets no pregnancy test or birth control requirement before starting.
- Tell the cardiologist if you are pregnant, planning a pregnancy or breastfeeding.FDA label
ForgingBridges enrollment and the insurance approval
The cardiologist's office faxes a Start Form with your insurance card, diagnosis code and prescription, and you sign a consent form.
- A Patient Access Liaison then helps with coverage and costs.
- New patients may get a free 1-month supply, and QuickStart may cover up to 2 months while insurance is delayed.ForgingBridges enroll
A call from the specialty pharmacy
Attruby comes from 2 authorized specialty pharmacies, Orsini and PANTHERx Rare, or from select health system pharmacies.
- The pharmacy or ForgingBridges calls to collect your insurance details.
- BridgeBio says the call may come from an unknown or 800 number, and to answer it.How to get Attruby
The days that matter
Counted from the first dose, with the 28-day refills the carton sets, the early kidney test change, and free supplies that bridge a slow approval. Type your first-dose date and the tiles become real dates you can add to your calendar.
The tiles below count days from a first dose. Enter the date of yours, or the date you expect, and each tile becomes a real date on your calendar.
The date stays on your device. It is not sent to Trial Friend or anyone else. The calendar file works with Apple, Google and Outlook calendars.Start Form, consent and the insurance request
The office sends the ForgingBridges Start Form with your diagnosis code and insurance card, and submits the prior authorization.
- You sign the program's consent form, either on paper or online.
The pharmacy or ForgingBridges calls
One of them calls you to confirm your insurance and set up delivery.
- BridgeBio says orders ship to your home within 48 hours after coverage is approved.
First dose, 2 tablets, then 2 more that evening
Two 356mg tablets twice a day, swallowed whole, with or without food.
- A carton holds 4 blister cards of 28 tablets, one card per week.
- A bottle of 120 tablets is also made and lasts 30 days.
The kidney blood test change
The label says creatinine rises and eGFR falls within 4 weeks of starting, then levels off.
- In the trial the rise averaged 0.2mg/dL, and the label says it reversed after stopping.
Refill, then about every 28 days
A 112-tablet carton runs out here, or on day 31 for a 120-tablet bottle.
- The copay card cannot be used more than once every 28 days.
Refill, number 2
If a free supply carried you
QuickStart supplies up to 2 months in 28-day steps while insurance is delayed, and ends once coverage is approved.
- ForgingBridges can say where the approval stands before the free supply runs out.
Refill, number 3
Three months in
The label reports near-complete TTR stabilization on lab tests by day 28.
- The benefits it measured, fewer deaths and fewer heart hospital stays, were counted over 30 months.
The label, revision by revision
The FDA lists which sections changed in each revision of a label. These are the revisions the current Attruby label records, dated by the FDA, with a plain note on what each one meant for a patient. Older references and handouts can lag these by months.
Current label dated June 29, 2026, read from the FDA's label database today. FDA label
- June 2026
The current label, revised in June 2026, lists a bottle of 120 tablets alongside the 112-tablet carton. The label approved in November 2024 listed only the carton. DailyMed's December 2025 version did not list the bottle either, and the FDA has posted no supplement letter for it.FDA label
- November 2024
The FDA approved Attruby on November 22nd for adults with ATTR cardiomyopathy, wild-type or variant, to reduce heart-related deaths and hospital stays. The approval requires a pregnancy and breastfeeding study, a liver impairment study and 2 drug interaction studies.FDA letter
How the label says to take it
The parts of the prescribing information and the patient leaflet that come up in the first 3 months, in plain words.
- Two tablets, twice a day, swallowed whole
The label dose is 712mg twice daily, taken as two 356mg tablets, with or without food.
- Tablets are swallowed whole and never cut, crushed or chewed.
- There is only one strength, and the label has no dose steps.FDA label
- If you miss a dose
Neither the label nor the Patient Information gives an instruction for a missed dose.
- The Patient Information says to take Attruby exactly as your healthcare provider tells you.
- Ask the pharmacist or cardiologist what to do before it happens.FDA label
- Keep tablets in the blister card
The label says to store tablets in the original blister card until use, to protect them from moisture.
- BridgeBio designed the cards as a daily pack with the tablets labeled and separated.Attruby dosing page
- Medicines that can lower Attruby levels
Attruby is cleared from the body mainly by a family of enzymes called UGT.
- The label says to avoid medicines that induce UGT enzymes and strong CYP3A inducers, because those can also induce UGT.
- Ask the pharmacist whether anything you take falls in these groups.FDA label
- Medicines Attruby can raise
Attruby blocks the CYP2C9 enzyme, which can raise levels of some other medicines.
- For sensitive CYP2C9 medicines, the label tells prescribers to consider closer monitoring for side effects.FDA label
- Kidney and thyroid blood tests
Creatinine may rise and eGFR may fall a little in the first 4 weeks, then hold steady.
- Free thyroxine may read lower without a change in TSH.
- Tell anyone who reads these blood tests that you take Attruby.FDA label
- Pregnancy
Tell your healthcare provider right away about a known or suspected pregnancy.
- The label also asks that pregnancies be reported to BridgeBio at 1-844-550-2246.FDA label
- Storage
Room temperature, 68 to 77 degrees Fahrenheit (20 to 25 Celsius), with brief periods from 59 to 86 degrees allowed.
- The Patient Information says to keep it out of the reach of children.FDA label
What the label says to act on
The symptoms the label singles out, and what it tells patients and prescribers to do about each. If any of these happen, the label's instruction is the one to follow, with your care team.
Diarrhea and stomach-area pain
In the ATTRibute-CM trial, diarrhea occurred in 11.6% of patients on Attruby against 7.6% on placebo.
- Upper belly pain occurred in 5.5% against 1.4% on placebo.
- Most cases were mild and went away without stopping the drug.FDA label
Changes that show up on blood tests
The early creatinine rise and the lower free thyroxine reading are lab findings, not symptoms.
- The label says the kidney test changes reversed after treatment stopped.FDA label
What the label does not list
Attruby has no boxed warning and no warnings section, so the label names no emergency symptoms of its own.
- The Patient Information says to call your doctor for medical advice about side effects.FDA label
Why the pharmacy or the insurer says no, and what fixes it
Most first-fill delays are one of these. Knowing which one tells you who to call.
- Prior authorization pending or deniedThe Cigna policy below wants the diagnosis confirmed by a heart scan, biopsy or genetic test, heart imaging, and heart failure short of NYHA class IV. A ForgingBridges Field Reimbursement Manager helps the office with prior authorizations and appeals.ForgingBridges HCP
- The plan wants Vyndamax tried firstIn Cigna's Individual and Family Plans, Attruby is covered after Vyndamax did not work well enough or was not tolerated, according to the prescriber. Cigna relies on the prescriber's account of how the earlier drug went.Cigna policy
- You already take tafamidis or a TTR silencerCigna does not cover Attruby used alongside tafamidis, Amvuttra, Onpattro, Tegsedi or Wainua. The cardiologist decides which drug continues, and the request then shows a single treatment.Cigna policy
- The prescription went to the wrong pharmacyAttruby ships from Orsini, PANTHERx Rare or select health system pharmacies. BridgeBio says it does not route prescriptions to health system pharmacies, so the office sends it there directly.Start Form
- Coverage is taking a whileQuickStart may supply up to 2 months free, in 28-day steps, for insured patients new to Attruby. The Free Trial gives new patients one free 1-month supply, once per lifetime.ForgingBridges terms
- A copay you cannot payWith commercial insurance, the copay program offers as little as $0 a month, subject to maximums. Medicare, Medicaid, TRICARE and VA patients are excluded from it by its terms. The Patient Assistance Program gives free drug to people who meet income rules, including Medicare patients.ForgingBridges terms
Cigna prior authorization policy, March 1, 2026
- Age 18 or older, with ATTR amyloidosis with cardiomyopathy, wild-type or hereditary
- Diagnosis confirmed by a technetium pyrophosphate heart scan, a tissue biopsy typed as TTR amyloid, or a genetic test showing a TTR variant, with documentation
- Heart imaging, such as an echocardiogram or cardiac MRI, showing the heart is involved
- Heart failure, but not New York Heart Association (NYHA) class IV
- Prescribed by, or in consultation with, a cardiologist or a doctor who specializes in amyloidosis
- In Individual and Family Plans, Vyndamax tried first without enough benefit or with a significant intolerance
- Not used together with tafamidis, Amvuttra, Onpattro, Tegsedi or Wainua
Approval length. A year at a time.
This policy took effect on March 1, 2026, before the June 2026 label revision, and cites the November 2024 label. The approved use has not changed between those 2 labels. Other plans set their own rules, too. The Blue Cross Blue Shield Federal Employee Program, for one, accepts only a genetic test or biopsy, not a heart scan. It also asks for a heart wall thickness of 12mm or more and an NT-proBNP of 300 or more. It is here as an example of what a plan asks for, not as a rule. Cigna policy
Who to call, and what they can do
The drugmaker's program handles most of the first-fill problems above. Charity funds and foundation help are on the help paying page.
- A Patient Access Liaison who helps you start Attruby, understand coverage, find financial help and work with the specialty pharmacy
- A copay program for commercial insurance, as little as $0 a month subject to maximum benefit amounts, not valid with Medicare, Medicaid, TRICARE, VA or other government coverage
- A Free Trial of a 1-month supply for patients new to Attruby, once per lifetime, excluding DoD, VA and TRICARE coverage
- QuickStart, up to a 2-month supply at no cost in 28-day steps while a new patient's insurance is delayed
- A Patient Assistance Program giving Attruby free to people with no or inadequate coverage who meet income rules, including Medicare patients
Details as the drugmaker publishes them. ForgingBridges terms
Five questions for the pharmacist or the support line
- Are you Orsini or PANTHERx Rare, and what number will your calls come from?
- Will I get the 28-day carton or the 30-day bottle, and when should I order my refill?
- I take these medicines and supplements. Are any of them UGT or strong CYP3A inducers, or sensitive to CYP2C9?
- What should I do if I miss a dose, since the label does not say?
- If I started on a free supply, when does my insurance need to take over?
Questions people ask in the first weeks
How long does it take to get Attruby after it is prescribed?
There is no fixed number of days for this step. There is no REMS or required test before the first fill, so the insurance approval is usually the slow step. BridgeBio says orders ship within 48 hours after coverage is approved. The Free Trial and QuickStart programs can supply it free while that happens.
Can I pick up Attruby at my regular pharmacy?
No, a regular drugstore does not stock it. BridgeBio says Attruby comes from 2 authorized specialty pharmacies, Orsini and PANTHERx Rare, and select health system pharmacies. Orsini and PANTHERx Rare ship it straight to your home.
Does Attruby need blood tests?
The label does not set any required blood test schedule. It does say creatinine rises and eGFR falls a little within 4 weeks of starting, then levels off. It also says free thyroxine can read lower without a TSH change.
What if I miss a dose of Attruby?
The label and Patient Information do not give a missed-dose instruction. The Patient Information says to take Attruby exactly as your healthcare provider tells you. Ask the pharmacist or cardiologist so you know before it happens.
Can I take Attruby with tafamidis or Amvuttra?
The Attruby label does not say anything about combining them. In the ATTRibute-CM trial, 14.9% of patients on Attruby added tafamidis after 12 months. Cigna's policy will not cover Attruby used together with tafamidis or a TTR silencer, and the cardiologist decides.
Why was Attruby denied by my insurance?
Cigna's policy, one example, wants proof of the diagnosis from a heart scan, biopsy or genetic test, and heart imaging. It also wants heart failure short of NYHA class IV and a cardiologist or amyloidosis specialist. Some Cigna plans want Vyndamax tried first, and ForgingBridges can help with an appeal.
Does Medicare cover Attruby?
BridgeBio says more than 90% of Medicare Part D patients have access with a final coverage decision, based on its own August 2025 data. The ForgingBridges copay program is closed to Medicare patients by its terms. Its Patient Assistance Program can supply it free to those who meet income rules.
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Sources
- DailyMed - ATTRUBY- acoramidis hydrochloride tablet, film coated (prescribing information and Patient Information, revised June 2026), BridgeBio Pharma, via DailyMed, June 29, 2026.
- ATTRUBY prescribing information, November 2024 (Drugs@FDA file 216540s000lbl.pdf), FDA, Drugs@FDA, November 22, 2024.
- ATTRUBY SPL version 6, effective December 16, 2025 (DailyMed archive download), BridgeBio Pharma, via DailyMed, December 16, 2025.
- Approved Risk Evaluation and Mitigation Strategies (REMS), FDA, November 7, 2026.
- Attruby Patient Support | ForgingBridges Attruby (acoramidis) Patient Site, BridgeBio Pharma, November 7, 2026.
- Financial Assistance | ForgingBridges Attruby (acoramidis) Patient Site, BridgeBio Pharma, November 7, 2026.
- Terms & Conditions | ForgingBridges Attruby (acoramidis) Patient Site, BridgeBio Pharma, November 7, 2026.
- Enroll | ForgingBridges Attruby (acoramidis) HCP Site, BridgeBio Pharma, November 7, 2026.
- ForgingBridges Support Program Start Form, BridgeBio Pharma, November 7, 2026.
- How to Get Attruby | ForgingBridges Attruby (acoramidis) HCP Site, BridgeBio Pharma, November 7, 2026.
- Insurance Coverage & Plans | ForgingBridges Attruby (acoramidis) HCP Site, BridgeBio Pharma, November 7, 2026.
- Attruby Access & Reimbursement Support | ForgingBridges Attruby (acoramidis) HCP Site, BridgeBio Pharma, November 7, 2026.
- Attruby® (acoramidis) Dosing & Packaging Information, BridgeBio Pharma, November 7, 2026.
- Amyloidosis – Attruby, Drug Coverage Policy IP0728, Cigna, March 1, 2026.
- Pharmacy Policy 5.75.046, Attruby, Blue Cross Blue Shield Federal Employee Program, April 1, 2026.
- NDA 216540 approval letter, Attruby (acoramidis) tablets, November 22, 2024, FDA, November 22, 2024.
This page explains what the FDA label, the drugmaker's support program and an insurer policy say. It is not medical advice and does not tell anyone to start, stop or change a medicine. Dosing, test timing and restarts after a gap are decisions for the prescribing cardiologist. Found an error? Use the report link in the footer and it will be checked against the source.