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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Eflapegrastim

Eflapegrastim
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Rolvedon INJECTION, SUBCUTANEOUS 13.2 mg/ 0.6 mL    
Comments:

If ordered, automatically interchange to the most cost-effective pegfilgrastim product in adult patients. Eflapegrastim may be utilized (i.e., no substitution) if Rolvedon is more cost effective than pegfilgrastim.

Restricted to use in the outpatient setting.

 

Reviewed: February 2024

 

Eflapegrastim-xnst (Rolvedon)

Last updated: Apr. 10, 2024






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