Medications Approved for Automatic Therapeutic Interchange Dosage Conversion Guidelines (Note: “Therapeutic Interchange” should be placed in the order comments)
Biosimilar and Reference Products Interchange List for Adults
Medication
Reference Drug or Biosimilar
Formulary Status
Automatic Therapeutic Interchange
Inpatient1
Outpatient
*New Starts/New Authorizations Only*
Soliris (eculizumab)
Reference
Formulary, restricted to OP (preferred) and inpatient use restricted to aHUS4
Use Soliris for aHUS only or recommend Ultomiris if ISP qualified5
Use Soliris unless third party payer requires other eculizumab product or recommend Ultomiris5
Bkemv (eculizumab-aeeb)
Epysqli (eculizumab-aagh)
Biosimilars
Formulary, restricted to OP
(not preferred)
Interchange to Soliris for aHUS only or recommend Ultomiris if ISP qualified5
Contact provider to change to Soliris unless third party payer requires other eculizumab product or recommend Ultomiris5
**Please ensure patient and provider is enrolled in the appropriate REMS program and has received appropriate vaccines**. Separate REMS program required for each product.
4Inpatient eculizumab use restricted for atypical hemolytic uremic syndrome only.
5Ultomiris is preferred over Soliris in the outpatient setting and for inpatient use if patient qualifies for the inpatient support program (ISP).
Restricted: Eculizumab is formulary restricted to outpatient use (not preferred) and inpatient use for aHUS only. Ultomiris is preferred over Soliris in the outpatient setting and for inpatient use if patient qualifies for the inpatient free drug program.
Medications Approved for Automatic Therapeutic Interchange Dosage Conversion Guidelines
(Note: “Therapeutic Interchange” should be placed in the order comments)
Biosimilar and Reference Products Interchange List for Adults
Medication
Reference Drug or Biosimilar
Formulary Status
Automatic Therapeutic Interchange
Inpatient1
Outpatient
*New Starts/New Authorizations Only*
Soliris (eculizumab)
Reference
Formulary, restricted to OP (preferred) and inpatient use restricted to aHUS4
Use Soliris for aHUS only or recommend Ultomiris if ISP qualified5
Use Soliris unless third party payer requires other eculizumab product or recommend Ultomiris5
Bkemv (eculizumab-aeeb)
Epysqli (eculizumab-aagh)
Biosimilars
Formulary, restricted to OP
(not preferred)
Interchange to Soliris for aHUS only or recommend Ultomiris if ISP qualified5
Contact provider to change to Soliris unless third party payer requires other eculizumab product or recommend Ultomiris5
**Please ensure patient and provider is enrolled in the appropriate REMS program and has received appropriate vaccines**. Separate REMS program required for each product.
4Inpatient eculizumab use restricted for atypical hemolytic uremic syndrome only.
5Ultomiris is preferred over Soliris in the outpatient setting and for inpatient use if patient qualifies for the inpatient support program (ISP).