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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.
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glofitamab

glofitamab
Drug Name Form Strength Infusion Center Available Restricted Non-formulary Ambulatory Available Interchange REMS
Columvi SOLUTION, INTRAVENOUS gxbm 1 mg/mL        
VIEW MORE Antineoplastic Agents
CLASS
100000
Additional Information and Links

OH Epic Formulary as treatment plan, restricted to:

  • Indication: Treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified, including DLBCL arising from indolent lymphoma, and high-grade B-cell lymphoma after two or more lines of systemic therapy
  • Service line: Hematology/Oncology
  • Formulary location: Inpatient, outpatient infusion
  • Service location: Inpatient, outpatient infusion, home infusion
  • Patient population: Adults
  • Prior authorization Required: Yes for outpatient
  • Restriction/criteria of use (all will apply unless specified):
    • Documented diagnosis of relapsed or refractory diffuse large B-cell lymphoma (DLBCL), including transformation of DLBCL from follicular lymphoma and high-grade B-cell lymphoma.
    • Have received two or more prior lines of therapy.
    • Patient must have ECOG performance status of 0-1.
    • Patient must be able to receive obinutuzumab (Gazyva) 7 days prior to administration of Columvi.
  • Complete 3-month MUE as recommended by High Value Drug Committee.

     

Last updated: Mar. 18, 2025

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