FormWeb • Patient restrictions

Houston Methodist

Approved Hospital Formulary

FormWeb QuickStart Questions or Suggestions?

Search by class Show Therapeutic Classes

Do Not Crush List

Add Formweb to your mobile device

Android iOS

Formulary synchronization in progress.
Please refer to Epic and your local pharmacy for available medications.

Houston Methodist

Approved Hospital Formulary

FormWeb QuickStart Questions or Suggestions?

Patient restrictions

Please review each of these drugs carefully.

aminolevulinic acid	Restricted to its FDA approved indication
ARIPiprazole	Aripiprazole (Abilify MaintenaÂ®) is restricted to patients with schizophrenia.
bebtelovimab	Restricted to use in accordance with EUA criteria. Included as an option consistent with the HM mAB tiered use criteria
belantamab mafodotin	Restricted to its FDA approved indication
brexucabtagene autoleucel	Restricted to patients with prior financial approval
bupivacaine/meloxicam	Restricted to use for FDA approved indications with concurrent use of other extended-release local anesthetics
calcitonin	Treatment of symptomatic hypercalcemia for patients who are unresponsive to IV therapy and are not appropriate candidates for pamidronate
cangrelor	Nonformulary restricted to use in patients without oral or enteral access undergoing emergent intracoronary stent placement that have not been treated with a GPIIb/IIIa inhibitor
caplacizumab	Inpatient use allowable for FDA-approved indication
cefiderocol	Restricted to patients with gram negative infections with documented resistance to other agents
denosumab	Restricted to patients with financial approval
eculizumab	Restricted to patients who are registered with the manufacturer, Alexion Pharmaceuticals, Inc. Restricted to FDA-approved indications (PNH or aHUS) or for transplant patients who meet criteria according to the solid organ transplant clinical practice guideline
edaravone	Restricted to patients with financial approval who have been registered with the drug manufacturer
esketamine	Restricted to patients enrolled in the Spravato REMS program who have financial approval to continue SpravatoTM after hospital discharge
fam-trastuzumab deruxtecan	Restricted to its FDA approved indication
fentaNYL	Transdermal patch is restricted to continuation of home therapy or conversion of oral therapy in opioid tolerant patients, defined as at least 60 mg of oral morphine daily (or equianalgesic dose of another opioid) for at least one week
ferumoxytol	Restricted to outpatient setting
fluPHENAZine	Fluphenazine decanoate (Prolixin decanoateÂ®) is restricted to patients with schizophrenia.
glucarpidase	Restricts to patients with clinically toxic plasma methotrexate concentrations (>1 Î¼M/L) and impaired renal function Requires a review of use by the HM Oncology Exception Review Panel physician
haloperidol	Haloperidol decanoate (HaldolÂ®) is restricted to patients with schizophrenia.
idecabtagene vicleucel	Restricted to patients with prior financial approval
letermovir	Restricted to inpatients in whom adequate transitions of care have been established regarding medication acquisition in the outpatient setting
lisocabtagene maraleucel	Restricted to patients with prior financial approval
luspatercept-aamt	Restricted to its FDA approved indication
maribavir	Inpatient use should be restricted to patients in whom adequate transitions of care have been established regarding medication acquisition in the outpatient setting (i.e. prior authorization, etc)
meropenem-vaborbactam	Restricted to patients with confirmed or suspected carbapenemase producing Enterobacteriaciae
paliperidone	Paliperidone palmitate (Invega SustennaÂ®) is restricted to patients with schizophenia and schizoaffective disorder.
polyethylene glycol 3350 with electrolytes	Plenvu is restricted to use as bowel cleansing agent in preparation for colonoscopy
ravulizumab	Restricted to patients registered with the Ultomiris REMS program
risperiDONE	Risperidone (Risperdal ConstaÂ®) is restricted to patients with schizophrenia and bipolar I disorder.
riTUXimab	Rituxan HycelaÂ® (rituximab and hyaluronidase human) is restricted to FDA-approved indications of follicular lymphoma, diffuse large B-cell lymphoma, and chronic lymphocytic leukemia
romosozumab-aqqg	Restricted to patients who have not had an MI or stroke within the preceding year
selexipag	IV selexipag is restricted to patients that have previously been receiving oral selexipag and are unable to tolerate medications by mouth
sotalol	IV sotalol is restricted to use in patients with CrCl >60 mL/min being initiated on sotalol for atrial fibrillation, with no other concurrent medical conditions that may extend length of stay
tafasitamab-cxix	Restricted to its FDA approved indication
tagraxofusp-erzs	Restricted to use for its FDA-approved indication; Restricted to use in patients with financial approval for outpatient treatment cycles
tisagenlecleucel	Financial approved required prior to administration

This site is intended for the staff of Houston Methodist.
While others may view accessible pages, Houston Methodist makes no warranty, express or implied,
as to the use of this information outside of Houston Methodist.