Formulary restrictions:

• Service Line: Hematology/Oncology
• Formulary Location: Outpatient infusion
• Service location: Outpatient infusion center, home infusion
• Patient Population: Adult
• Prior Authorization Required: Yes
• Restriction/Criteria of Use:
  • Women with recurrent or metastatic cervical cancer with disease progression on or after chemotherapy
  • Must have received at least 1 line of chemotherapy, preferably a platinum-containing regimen

Although Tidvak does not participate in a REMS program, there are significant adverse reactions such as ocular toxicity. Recommend providers to order eye exams prior to initiation of therapy. However, this will rely on the providers order and monitor closely

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