FormWeb • selexipag

Henry Ford Health

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Brand name products with an equivalent generic may not be available to order at Henry Ford Health. For questions, contact inpatient pharmacy.

Henry Ford Health

Approved Hospital Formulary

FormWeb QuickStart Questions or Suggestions? Pharmacy Intranet

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selexipag

selexipag

Drug Name	Form	Strength	Clinic Use Only	Inpatient Restrictions	Outpatient Restrictions	Non-Formulary
Uptravi	POWDER FOR INJECTION, INJECTABLE	1800 mcg vial
Uptravi	TABLET, ORAL	200 mcg; 400 mcg

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Last updated: Sep. 17, 2019

Policy Tier 1: Inpatient use of selexipag

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