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Medications not yet evaluated by P&T are considered NON-FORMULARY. Always check 2 unique patient identifiers - NAME and DATE OF BIRTH - at every step!
Please be sure to document all clinical activities daily.
Approved Hospital Formulary
Suggestions or Corrections? Above and Beyond Nominations Formulary Request
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ravulizumab

ravulizumab
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Ultomiris SOLUTION, INTRAVENOUS 300 mg/30 mL      
Comments:

Inpatients: Restricted to oncologist/hematologist use via Ultomiris Inpatient Free Dose Program (up to 3 doses).

 

Outpatients: Ultomiris is restricted to oncologists/hematologists in the hospital outpatient setting using patient assistance programs (PAP) ONLY. If outpatient use other than PAP is deemed medically necessary, refer prescriber to eculizumab (SOLIRIS).

 

Ultomiris medication guide

REMS: View FDA REMS info

Reviewed: 24 Sept 2019 (Ultomiris)

Updated: Aug 2026 (Ultomiris)

Last updated: Aug. 26, 2026






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