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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corticotropin

corticotropin
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Acthar Gel, H.P. SOLUTION, INJECTABLE 80 units/mL      
Comments:

Acthar Gel, H.P. medication guide

ACTH Gel Injection – (H.P. ACTHAR GEL) – costs $23,000/vial.  Formulary status, restricted to infantile spasms or when no other drug can be used.

Reviewed:  September 25, 2007 and December 14, 2010

Last updated: Nov. 16, 2022






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