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.
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C1 esterase inhibitor, human

C1 esterase inhibitor, human
  • Restricted Miscellaneous Program Formulary
  • Restricted Cinryze --> Restricted to HAE patients with specific patient evaluation and approval by pharmacy administration.
  • Restricted Berinert --> Restricted to patients with hereditary angioedema having acute attack symptoms.
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Berinert KIT, INTRAVENOUS 500 intl units      
Cinryze POWDER FOR INJECTION, INTRAVENOUS 500 units      
VIEW MORE Immunomodulatory Agents
CLASS
922000
Comments:

Cinryze Use Procedure

Cinryze is classified as formulary, restricted to specific patient evaluation and approval. The drug is usually supplied directly to the patient by specialty pharmacy. For hospital use, investigate the patient using their own supply first. The drug may be sent to the hospital under certain circumstances through specialty pharmacy, with possible buy/bill or specialty pharmacy financing.

 

Berinert is classified as formulary status, restricted to individual patients with hereditary angioedema having acute attack symptoms.

 

Reviewed: March 24, 2009 (Cinryze) and June 22, 2010 (Berinert)

Last updated: Jan. 25, 2024






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