FormWeb • poly-L-lactic acid

Huntsville Hospital

Approved Hospital Formulary

Suggestions or Corrections? Above and Beyond Nominations Formulary Request

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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.

Huntsville Hospital

Approved Hospital Formulary

Suggestions or Corrections? Above and Beyond Nominations Formulary Request

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poly-L-lactic acid

poly-L-lactic acid

Non-formulary Rarely Used Drugs and Expensive (RUDE)

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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