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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ravulizumab

ravulizumab
  • Non-formulary Ultomiris --> Restricted to outpatient hematologists using patient assistance program.
Drug Name Form Strength Formulary Unrestricted Formulary Restricted Non-Formulary Interchange
Ultomiris SOLUTION, INTRAVENOUS 300 mg/30 mL      
Comments:

Ultomiris is restricted to hematologists in outpatient using patient assistance program (PAP).  Using PAP results in a patient-specific supply being delivered to the facility.  Ultomiris is considered non-formulary and should not be orderd from alternative means.

 

If outpatient use other than PAP is deemed medically necessary, refer prescriber to eculizumab (SOLIRIS).

Reviewed: 24 Sept 2019 (Ultomiris)

Last updated: Oct. 9, 2019






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