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Approved Hospital Formulary

Formulary Addition Requisition (Position 1)

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Approved Hospital Formulary

Formulary Addition Requisition (Position 1)

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Please review each of these drugs carefully.

abatacept
acetaminophen	Acetaminophen IV - See Drug Detail Page
ado-trastuzumab emtansine	This medication is Inpatient Non-formulary and Restricted to Outpatient Use. Inpatient use requires approval by a physician department leader (ie Medical Director or Chair, or hospital CMO) collaborating with a pharmacy leader.
alirocumab	To clinic use
alosetron	Restricted to registered physicians
alvimopan	Is Formulary and Restricted to patients undergoing small or large bowel resection, or radical cystectomy with urinary diversion only.
baricitinib	Use should be restricted to only those patients who meet EUA criteria
bortezomib	only stock the brand name Velcade product at all sites to decrease the risk of the alternative product accidentally being used when ordered via the SQ route
cabazitaxel	Restricted to Outpatient (see IP criteria for use)
DAPTOmycin	Reserved for MRSA infections ONLY if clinical intolerance to or failure of first line agents; not in pneumonia
denosumab	Biosimilar Preference List
filgrastim	Biosimilar Preference List
glucarpidase	For inpatient adult and pediatric use by authorized chemotherapy providers. Restricted to a one-time dose. Due to cost, Pharmacy Second Level Review required.
omeprazole	See Drug Detail Page
rifAMPin	IV: Antimicrobial Program criteria
valGANciclovir	ID approval needed. Exception: Unrestricted use for solid organ and bone marrow transplant patients.

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