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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poly-L-lactic acid

poly-L-lactic acid
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Sculptra POWDER FOR INJECTION, INJECTABLE      
Comments:

Sculptra-- Used for cosmetic restoration and correction of lipoatrophy and facial fat loss. This is an outpatient procedure and currently not performed for HH inpatients. Drug is not supplied to hospitals, only supplied to MD offices. Cost $800 for one treatment session. Purchase/ use must first be re-evaluated and approved by P&T Committee.

Last updated: Oct. 16, 0002






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