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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Dostarlimab-gxly

Dostarlimab-gxly
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Jemperli INJECTION, INTRAVENOUS 50 mg/mL      


Comments:

Restricted to use by Oncology in the outpatient setting. Reimbursement and insurance certification or PAP eligibility will be reviewed prior to initiation of therapy.


Reviewed: April 2022 (Jemperli)

Dostarlimab-gxly (Jemperli)


Last updated: Dec. 28, 2023







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