OH Formulary Restrictions:

• Indication: treatment of adult patients with relapsed or refractory multiple myeloma who have received at least four prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.
• Service line: Hematology/Oncology
• Formulary location: Inpatient, Outpatient Infusion
• Service location: Inpatient, Outpatient Infusion, Home Infusion
• Patient population: Adult
• Prior authorization required: Yes – before admission for inpatient and for outpatient
• Restriction/criteria of use (all will apply unless specified):
  • Documented diagnosis of relapsed or refractory multiple myeloma
  • Have received at least four prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.
  • Patient must have ECOG performance status (PS) of 0-2
  • Females of reproductive potential: negative pregnancy test
  • Prescribers and pharmacies/healthcare settings must be certified and comply with the ELREXFIO REMS program requirements

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