FormWeb • High Cost Drugs

Rpharmy Memorial

Approved Hospital Formulary

Formulary Addition Requisition (Position 1)

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Rpharmy Memorial Formweb Change Request (Position 2)

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Rpharmy Memorial

Approved Hospital Formulary

Formulary Addition Requisition (Position 1)

Demo Page

Rpharmy Memorial Formweb Change Request (Position 2)

High Cost Drugs

Please review each of these drugs carefully.

abatacept	AWP $1,500-$4,500
alirocumab	AWP $270/75 mg; $1,250/300 mg
bortezomib	Approx AWP $1,900/dose
cabazitaxel	Approx AWP $14,000/dose
glucarpidase	~$24,805 per vial
rifAMPin	See Notes

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