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Medications listed are available on OH EPIC Formulary, unless otherwise noted.
Not all formulary medications are available at each facility. Please refer to your local pharmacy for available inventory.
Search results for:

amivantamab

amivantamab
Drug Name Form Strength Infusion Center Available Restricted Non-formulary Ambulatory Available Interchange REMS
Rybrevant SOLUTION, INTRAVENOUS vmjw 50 mg/mL        
VIEW MORE Antineoplastic Agents
CLASS
100000
Additional Information and Links

OH Formulary restrictions:

  • Service Line: Hematology/Oncology
  • Formulary Location: Outpatient infusion
  • Service location: Outpatient infusion center
  • Patient Population: Adult
  • Prior Authorization Required: Yes
  • Restriction/Criteria of Use:
    • Patient must have confirmed metastatic or unresectable nonsquamous NSCLC with: 
      • An EGFR exon 20 insertion mutation (as detected by an FDA approved test) and has progressed on or after platinum-based chemotherapy
        • OR
      • Treatment-naïve, EGFR exon 20 insertion mutation, amivantamab combined with platinum therapy (carboplatin/pemetrexed)
        • OR
      • Progression on osimertinib, EGFR exon 19 deletion or exon 21 L858R mutation, amivantamab combined with a platinum doublet (carboplatin/pemetrexed).

 

 

 

Last updated: Mar. 20, 2024

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