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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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nirsevimab

nirsevimab
Drug Name Form Strength Infusion Center Available Restricted Non-formulary Ambulatory Available Interchange REMS
Beyfortus SOLUTION, INTRAMUSCULAR alip preservative-free 100 mg/mL      
VIEW MORE Monoclonal Antibodies
CLASS
081824
Additional Information and Links

Formulary restrictions:

  • Indication: Prevention of Respiratory Syncytial Virus (RSV) lower respiratory tract disease in neonates and infants born during or entering their first RSV season and children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season.
  • Formulary location: Inpatient, Ambulatory and Outpatient Infusion
  • Service location: Inpatient, Clinic and Outpatient Infusion
  • Patient population: Pediatric and Neonates
  • Prior authorization required: Possible
  • Restriction/criteria of use (all will apply unless specified):
    • Service location: Ambulatory and Outpatient Infusion 
      • Service line: Pediatricians, Pediatric Infectious disease, Pediatric Pulmonology, and Pediatric Cardiology
    • Service location: Inpatient
      • Newborns admitted to NICU/PICU during RSV season and expected hospital stay of greater than 7 days
      • AND High risk newborn patients:
        • Newborns with congenital malformations or congenital heart disease
        • OR Newborns with prenatal age of <32 weeks
        • OR Newborns with failure to thrive
Last updated: Oct. 23, 2023

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