Approved Hospital Formulary
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Approved Hospital Formulary
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letermovir

letermovir
  • Provider restrictions: Infectious Disease and Bone Marrow Transplant ONLY
  • Patient restrictions: Restricted to inpatients in whom adequate transitions of care have been established regarding medication acquisition in the outpatient setting
Brand names: Prevymis
Form Strength
SOLUTION, INTRAVENOUS 240mg, 480 mg
TABLET, ORAL 240 mg, 480 mg


 

Restriction detail footnote: Inpatient use should be restricted to patients in whom adequate transitions of care have been established regarding medication acquisition in the outpatient setting (i.e. completed prior authorization forms with affordable copays adjudicated on a patient-to-patient basis or enrollment into a medication-assistance program if the patient cannot afford copays)

Policies and procedures

 

Consults, protocols, and therapeutic interchanges

 

Additional information


Last updated: Aug. 3, 2019


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