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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:

avacincaptad pegol

avacincaptad pegol
Drug Name Form Strength Infusion Center Available Restricted Non-formulary Ambulatory Available Interchange REMS
Izervay SOLUTION, INTRAVITREAL 2 mg/0.1 mL        
VIEW MORE EENT Drugs, Miscellaneous
CLASS
529200
Additional Information and Links

OHS Formulary Restricted

  • Indication: Geographic atrophy (GA)secondary to age-related macular degeneration
  • Service line: Ophthalmology – Retina service
  • Formulary location: Ambulatory
  • Service location: Ophthalmology clinic
  • Patient population: Adults
  • Prior authorization Required: yes
  • Criteria of use:
    • Must not have geographic atrophy (GA) secondary to a condition other than dry age-related macular degeneration (AMD)
    • No ocular or periocular infections
    • No active intraocular inflammation
    • Alternative to pegcetacoplan (Syfovre) for patients with retinal vasculitis concerns
Last updated: Nov. 13, 2023
  • Ambulatory: Ophthalmology clinic

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