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)
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