FormWeb • gallium ga-68 gozetotide

Ochsner Health

Ochsner Health System Formulary

Formulary Addition Request Questions or Suggestions?

SDS Online Do Not Crush OHS Pharmacy Contact Louisiana Poison Control
(800) 222-1222

Webpage Links

Add Formweb to your mobile device

Android iOS

Ochsner Health COVID-19 SharePoint Site "Safety On Site" Click here to enter an S.O.S.

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.

Ochsner Health

Ochsner Health System Formulary

Formulary Addition Request Questions or Suggestions?

Search results for:

gallium ga-68 gozetotide

gallium ga-68 gozetotide

Drug Name	Form	Strength	Infusion Center Available	Restricted	Non-formulary	Ambulatory Available	Interchange	REMS
Illuccix	KIT, INTRAVENOUS	25 mcg
Locametz	KIT, INTRAVENOUS	25 mcg

VIEW MORE Roentgenographic and Other Imaging Agents
CLASS

Additional Information and Links

Illuccix restricted to:

Service Line: Radiology/Nuclear Medicine
Formulary Location: Outpatient
Service location: Outpatient Nuclear Medicine
Patient Population: Adult
Prior Authorization Required: Yes
Criteria of Use: Alternative to piflufolastat F 18 (Pylarify)

Note: Locametz is NON-formulary

Last updated: Jan. 26, 2023

This site is intended for the staff of Ochsner Health. While others may view accessible pages, Ochsner Health makes no warranty, express or implied, as to the use of this information outside of Ochsner Health.