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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Crizanlizumab-tmca

Crizanlizumab-tmca
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Adakveo SOLUTION, INTRAVENOUS 100 mg/10 mL      


Comments:

Formulary restricted to hematology/oncology in the outpatient setting, insurance certification or PAP eligibility to be completed prior to treatment, each case will be individually evaluated for reimbursement and financial status.

Adakveo may be initiated inpatient if patient is eligible for the Novartis Patient Assistance Now Oncology Program or the Adakveo Access Program (patient own medication). Otherwise, initiation should be deferred to the outpatient setting.

 


Reviewed: June 2020

High Value Care Committee: May 2021 - Approved


Last updated: May. 28, 2021







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