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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eculizumab

eculizumab
  • Restricted Soliris --> Restricted to hematology/oncology and nephrology and strictly adhere to approved criteria for use.
  • Restricted Soliris --> Notify member of pharmacy admin if ordered.
  • Restricted Miscellaneous Programs
  • Therapeutic Interchange
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Epysqli INJECTION, INTRAVENOUS 10 mg/mL    
Bkemv SOLUTION, INTRAVENOUS 10 mg/mL    
Soliris SOLUTION, INTRAVENOUS 10 mg/mL    
VIEW MORE Complement Inhibitor Agents
CLASS
902000
Comments:

Soliris medication guide

Soliris Criteria for Use

Restricted to hematology/oncology and nephrology. Strictly adhere to approved criteria for use.

Soliris, Bkemv, and Epysqli are classified as therapeutically equivalent for the FDA-approved indications. The most cost-effective product will be utilized.

Reviewed date: July 24, 2007 and 28 Feb 2017 (High Impact Committee), November 2024 ,May 2025(Epysqli)

Eculizumab-aeeb (BKEMV) Spotlight.pdf

REMS: View FDA REMS Info

 

Last updated: May. 29, 2025






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