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Huntsville Hospital

Approved Hospital Formulary

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Medications not yet evaluated by P&T are considered NON-FORMULARY . . . . . Always check 2 unique patient identifiers - NAME and DATE OF BIRTH - at every step! . . . . . Please be sure to document all clinical activities daily.

Huntsville Hospital

Approved Hospital Formulary

Suggestions or Corrections? Above and Beyond Nominations Formulary Request

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Please review each of these drugs carefully.

abarelix	Anti-Neoplastic Formulary Plenaxis --> Restricted to oncology.
abatacept	Miscellaneous Program Formulary Orencia IV --> Restricted to Outpatient Medical.
abobotulinumtoxinA	Miscellaneous Program Formulary Dysport --> Restricted to Huntsville Hospital Neurological Associates Clinic & Pain Center.
acetaminophen	Miscellaneous Programs Formulary
acetaminophen-codeine	Narcotic Liquids Formulary Narcotic - Oral Formulary Codeine is not to be used in children < 18 years old or in breastfeeding mothers. Contact MD for alternative therapy.
acetaminophen-oxyCODONE
acetaminophen-traMADol	Narcotic - Oral Formulary Tramadol is not to be used in children < 18 years old or in breastfeeding mothers. Contact MD for alternative therapy.
acetylcholine	Miscellaneous
acetylcysteine	Acetadote--> Protocol for use.
aclidinium	Anticholinergic and Combinations Inhalers Tudorza Pressair --> Restricted to NO SUB orders.
adefovir	Miscellaneous Program Formulary Hepsera --> Restricted to continuation of therapy when patient supply unavailable.
ado-trastuzumab emtansine	Anti-Neoplastic Formulary
agalsidase beta	Miscellaneous Program Formulary Fabrazyme --> Restricted to Outpatient Medical and admin approval.
albuterol	Albuterol MDI --> Restricted to scheduled treatments, Pediatrics or ADULT PRN order keep at bedside, self-administered or for educational use.
alefacept	Miscellaneous Programs Amevive --> Restricted to continuation of therapy.
alemtuzumab	Miscellanous Formulary Campath --> Restricted to Oncology use.
alendronate	Bisphosphonate Formulary Fosamax --> 35 mg tablet restricted to Paget's Disease only.
alfuzosin	Alpha-Blockers Formulary Uroxatral --> Restricted to NO SUB orders.
alglucosidase alfa	Rarely Used Drugs and Expensive (RUDE) Lumizyme, Myozyme --> Restricted to Outpatient Medical with administration approval.
almotriptan	Triptan Formulary Axert --> Restricted to NO SUB orders.
alpha 1-proteinase inhibitor	Miscellaneous Programs Prolastin-C, Zemaira, Aralast --> Restricted to Outpatient Medical.
ALPRAZolam	ODT restricted to NO SUB orders.
alvimopan	Miscellaneous Program Formulary
aminolevulinic acid	Gleolan --> restricted to neurosurgery.
amitriptyline-perphenazine
Amivantamab-vmjw	Anti-Neoplastic Formulary
amLODIPine	Katerzia-->restricted to pediatric use.
amoxicillin-clavulanate	Augmentin XR --> restricted to NO SUB. Augmentin ES-600--> Restricted to pediatric patients under 40 kg.
amphotericin B	Amphotericin B Formulary Fungizone --> Restricted to use in neonates
anakinra	Miscellaneous
anti-inhibitor coagulant complex	FEIBA--> restricted to emergent reversal of oral anticoagulants for cases involving bleeding or surgery, control/prevention of bleeding in patients with hemophilia, or bleeding unresponsive to alternative therapies. See prescriber restrictions below.
antihemophilic factor-von Willebrand factor
aprepitant	Miscellaneous Program Formulary Anti-Neoplastic Formulary Emend --> Restricted to cases meeting specific criteria listed below. Cinvanti --> Restricted to use by oncology.
ARIPiprazole	Aristada and Aristada Initio --> 1,064 mg and 675 mg are restricted to use by psychiatrists (or with a psychiatrist consult) and initiation of therapy (or re-initiation of therapy if patient has been off drug for several weeks). Abilify --> oral solution is restricted to pediatrics.
artemether-lumefantrine	Miscellaneous Programs Coartem --> Restricted to infectious disease for initiation of therapy.
artesunate	Miscellaneous
ascorbic acid	Criteria for Use
asparaginase Erwinia chrysanthemi	Oncology Formulary Erwinaze --> Restricted to St. Jude Clinic.
asparaginase Erwinia chrysanthemi, recombinant	Anti-Neoplastic Formulary
atezolizumab	Anti-Neoplastic Formulary Tecentriq --> restricted to outpatient oncology use.
atropine-pralidoxime	Miscellaneous Programs DuoDote --> Restricted to use for a public emergency.
avalglucosidase alfa	Miscellaneous Formulary
avelumab	Anti-Neoplastic Formulary Bavencio --> restricted to oncology outpatient infusion areas.
avibactam-cefTAZidime	Cephalosporin, Third Generation (Injectable) Formulary Avycaz --> restricted to ID for documented carbapenem-resistant Enterobacteriaceae(CRE) and cannot tolerate other options. Policy for Systemic Antibiotics for the Treatment of Carbapenem-Resistant Gram-Negative Bacterial Infections in ADULTS
azaCITIDine	Vidaza --> Restricted to oncology.
azilsartan	Angiotensin II Receptor Antagonist Formulary Edarbi --> Restricted to NO SUB orders.
baricitinib	Miscellaneous Programs Baricitinib Criteria For Use
bebtelovimab	Miscellaneous Bebtelovimab Criteria for Use
beclomethasone nasal	Intra-Nasal Steroids Formulary Beconase AQ --> Restricted to NO SUB orders ~OR~ dose higher than the listed interchange.
belatacept	Miscellaneous Programs Nulojix --> Restricted to nephrology.
belimumab	Miscellaneous Programs Benlysta IV --> Restricted to Outpatient Medical.
belinostat	Anti-Neoplastic Formulary Beleodaq --> Restricted to Outpatient Medical
benazepril	ACE Inhibitor Formulary Lotensin --> Restricted to NO SUB orders ~OR~ dose higher than the listed interchange.
benazepril-hydroCHLOROthiazide	ACE Inhibitor/Hydrochlorothiazide Combination Formulary Lotensin HCT --> Restricted to NO SUB orders.
bendamustine	Anti-Neoplastic Formulary Bendeka, Treanda --> Restricted to Oncology and admin approval.
benralizumab	Fasenra --> restricted to outpatient. Miscellaneous Programs
benzathine benzylpenicillin	Miscellaneous Formulary
betaxolol	Beta-Blocker Formulary Kerlone --> Restricted to NO SUB orders.
bevacizumab	Anti-Neoplastic Formulary VEGF Inhibitors for Macular Degeneration Formulary Avastin --> retinopathy of prematurity in neonates (inpatient/rare), macular degeneration cases(outpatient) Alymsys/Mvasi/Avastin/Avzivi/Zirabev --> is approved for oncology use in outpatient.
bezlotoxumab	Miscellaneous Programs Restricted to ID & GI physicians in the outpatient setting following criteria for use
bimatoprost ophthalmic	Ophthalmic Prostaglandin Analog Formulary Lumigan 0.01% --> Restricted to NO SUB orders.
bisoprolol	Beta Blocker (Oral) Formulary Zebeta --> Restricted to NO SUB orders.
bivalirudin	Miscellaneous Program Formulary Angiomax --> Restricted to Cath Lab ~OR~ HIT protocol.
blinatumomab	Anti-Neoplastic Formulary Blincyto --> Restricted to oncology and admin approval.
boceprevir	Miscellaneous Programs Victrelis --> Restricted to continuation of therapy.
bortezomib	Anti-Neoplastic Formulary Velcade --> Restricted to oncology.
brentuximab vedotin	Anti-Neoplastic Formulary Adcetris --> Restricted to outpatient with administration approval.
brincidofovir	Miscellaneous
brivaracetam	Miscellaneous Programs Hospital initiation restricted to neurology (including pediatric neurology).
budesonide	Miscellaneous Program Formulary Pulmicort Flexhaler --> Restricted to pediatrics less than 12 years old. Uceris, Entocort EC --> Restricted to the continuation of therapy and unable to use home supply.
budesonide nasal	Intra-Nasal Steroids Formulary Rhinocort Aqua --> Restricted to NO SUB orders ~OR~ dose higher than the listed guidelines.
bumetanide	Loop Diuretic Formulary Bumex --> Restricted to NO SUB orders.
buprenorphine	Buprenex--> Restricted to NO SUB orders.
buPROPion
butorphanol	Stadol--> Restricted to NO SUB orders.
C1 esterase inhibitor, human	Miscellaneous Program Formulary Cinryze --> Restricted to HAE patients with specific patient evaluation and approval by pharmacy administration. Berinert --> Restricted to patients with hereditary angioedema having acute attack symptoms.
cabazitaxel	Anti-Neoplastic Formulary Jevtana --> Restricted to Oncology and approval from administration prior to use.
caffeine	Miscellaneous Programs
calaspargase pegol	Anti-Neoplastic Formulary
calcitonin	Injection --> Restricted to uses other than osteoporosis or Paget's disease. Restricted to specialists in oncology, nephrology, endocrinology, or ED. Hospitalists limited to use for hypercalcemia of malignancy via PowerPlan
calcium-vitamin D
candesartan	Angiotensin II Receptor Antagonist Formulary Atacand --> Restricted to NO SUB orders.
candesartan-hydroCHLOROthiazide	Angiotensin II Receptor Antagonist/Hydrochlorothiazide Formulary Atacand HCT --> Restricted to NO SUB orders.
cannabidiol	Epidiolex ->Restricted to pediatrics.
caplacizumab	Miscellaneous Programs
carbon-11 choline	Restricted to imaging
carbon-14 urea	Restricted to imaging
carfilzomib	Oncology Formulary Kyprolis --> Restricted to Outpatient Medical.
cariprazine	Antipsychotics Formulary Intiation by a psychiatrist or continued maintenance therapy.
caspofungin	Echinocandin Formulary Cancidas --> restricted to ID use when micafungin is not a viable option.
cefiderocol	Miscellaneous Programs
cefotaxime	Claforan --> Restricted to NO SUB orders. Claforan --> DO NOT convert Claforan to Rocephin in PEDS (â‰¤ 12 years old). Claforan --> DO NOT interchange Claforan in cases of pre-op surgery doses or in 'taxmet' regimens.
cefoTEtan	Cephalosporin Anaerobic Generation Formulary Cefotan --> Restricted to NO SUB orders.
ceftaroline	Cephalosporin, Third Generation (Injectable) Formulary Teflaro --> For use by Infectious Disease or Critical Care Specialists ~OR~ any physician for acute skin and skin structure infections.
cefTAZidime	Cephalosporin (Third Generation Injectable) Formulary Fortaz, Tazicef --> Restricted to ID, nephrology, pediatrics, and continuation of home therapy.
ceftolozane-tazobactam	Miscellaneous Program Formulary Zerbaxa --> restricted to ID for documented MDR Pseudomonas when other options are not appropriate. Policy for Systemic Antibiotics for the Treatment of Carbapenem-Resistant Gram-Negative Bacterial Infections in ADULTS
cemiplimab-rwlc
cenobamate	Miscellaneous Programs Xcopri --> restricted to neurologist initiation for inpatients.
certolizumab	Miscellaneous Programs Cimzia --> can be used in Outpatient Medical. Cimzia ---> Restricted to GI physicians for rare cases of pre-surgery treatment of Crohn's disease or those severe cases not responding to conventional therapy.
cetuximab	Anti-Neoplastic Formulary Erbitux --> Restricted to outpatient oncology and inpatient head or neck cancer being treated with radiation therapy and unable to receive CISplatin.
chlorothiazide	Diuril --> oral suspension restricted to use in pediatrics.
chlorTHALidone
cidofovir	Miscellaneous
ciprofloxacin	Quinolone Formulary Cipro --> Restricted to NO SUB orders.
clevidipine	Miscellaneous Programs Cleviprex --> Restricted to critical care units (ICU, ER, Surgery).
clofarabine	Anti-Neoplastic Formulary Clolar --> Restricted to Oncology and pharmacy administration approval.
clonazePAM	KlonoPIN Wafer --> Restricted to pediatrics.
cloNIDine	Duraclon --> restricted to pediatric anesthesiology for caudal epidural use.
clorazepate	Benzodiazepine Formulary Tranxene T-Tab --> Restricted to NO SUB orders.
cloxacillin	Penicillinase Resistant Penicillin Formulary Cloxapen --> Restricted to NO SUB orders.
coagulation factor VIIa	Miscellaneous Programs
coal tar topical	Shampoo - Medicated Formulary
codeine	Narcotic Liquids Formulary Narcotic - Oral Formulary Codeine is not to be used in children < 18 years old or in breastfeeding mothers. Contact MD for alternative therapy.
colistimethate	Coly Mycin M --> Restricted to infectious disease, trauma, adult and pediatric critical care, and pulmonology.
copanlisib	Aliqopa --> restricted to oncology use in outpatient infusion center or clinic. Anti-Neoplastic Formulary
copper-64 dotatate
corticotropin	Miscellaneous Programs Acthar Gel, H.P. --> Restricted to infantile spasms
Crizanlizumab-tmca	Miscellaneous Programs
cytarabine liposomal	Anti-Neoplastic Formulary DepoCyt --> Restricted to oncology or neurosurgery.
dalbavancin	Miscellaneous Programs Dalvance --> restricted to outpatient use OR use in ER by ID physician
dalteparin	LMWH Formulary Restricted to No sub, shortage/outage
DAPtomycin	Miscellaneous Program Formulary Cubicin --> Restricted to Infectious Disease physician.
daratumumab	Anti-Neoplastic Formulary Darzalex --> Restricted to oncology.
daratumumab-hyaluronidase-fihj	Anti-Neoplastic Formulary
darbepoetin alfa	Erythropoietin Formulary Aranesp --> Restricted to Outpatient Medical.
darifenacin	Anti-cholinergic (Overactive Bladder) Formulary Enablex --> Restricted to NO SUB orders.
daunorubicin liposomal-cytarabine liposomal	Vyxeos --> restricted to oncology.
decitabine	Anti-Neoplastic Formulary Dacogen --> Restricted to hematology-oncology use. Patients should have tried other available therapies before receiving decitabine.
degarelix	Anti-Neoplastic Formulary Firmagon --> Restricted to oncology and urology.
denosumab	Miscellaneous Program Formulary Prolia, Xgeva --> Restricted to outpatient areas.
desoximetasone topical	Corticosteroid (Topical) Formulary
dexlansoprazole	Huntsville Hospital Proton Pump Inhibitor Formulary
dextromethorphan-quiNIDine	Miscellaneous Programs Nuedexta --> Restricted to initiation by neurology physician and psychiatry. Orders to continue home therapy maybe written by any physician.
diclofenac	NSAID Formulary Voltaren --> Restricted to NO SUB orders
diclofenac topical	NSAID Formulary Flector --> limited to patients with renal insufficiency or where oral NSAID therapy is undesirable in cases of minor injuries. Voltaren --> limited to patients to treat osteoarthritis with renal insufficiency or increased risk for adverse effects from systemic NSAID use.
diflorasone topical	Corticosteroid (Topical) Formulary
dolutegravir	Tivicay PD --> restricted to pediatric patients with HIV-1 infection who are INSTI-naive, at least 4 weeks old, and weigh at least 3 kg.
Dostarlimab-gxly	Anti-Neoplastic Formulary
doxazosin	Alpha-Blocker Formulary Cardura --> Restricted to NO SUB orders.
doxercalciferol	Vitamin D Analogs Formulary Hectorol --> Restricted to NO SUB orders.
durlobactam-sulbactam	Miscellaneous Program Formulary
durvalumab	Imfinzi --> Restricted to oncology outpatient infusion.
ecallantide	Kalbitor --> Restricted to Hospital Outpatient and ER. Miscellaneous Programs
eculizumab	Soliris --> Restricted to hematology/oncology and nephrology and strictly adhere to approved criteria for use. Soliris --> Notify member of pharmacy admin if ordered. Miscellaneous Programs
edetate calcium disodium	Miscellaneous Formulary
edoxaban	Savaysa --> restricted to NO SUB orders following guidelines below.
Eflapegrastim	Granulocyte Colony-Stimulating Factors (GCSF/GMCSF) Formulary
eletriptan	Triptan Formulary Relpax --> Restricted to NO SUB orders.
elosulfase alfa	Vimizim --> Restricted to Outpatient Medical. Miscellaneous Programs
elotuzumab	Empliciti --> Restricted to Outpatient Medical. Anti-Neoplastic Formulary
eluxadoline	Viberzi --> Restricted to continuation of home therapy ~OR~ initiation by GI specialist Miscellaneous Programs
emicizumab	Hemlibra--> Restricted to outpatient hematology/oncology use.
enalapril	Epaned --> Restricted to pediatrics only.
eplerenone	Miscellaneous Program Formulary Inspra --> Restricted to NO SUB orders.
epoprostenol	Veletri (IV) --> restricted to pulmonology/medical-intensivist, cardiology, rheumatology, and pediatric critical care Miscellaneous
eprosartan	Angiotensin II Receptor Antagonist Formulary Teveten --> Restricted to NO SUB orders.
eprosartan-hydroCHLOROthiazide	Angiotensin II Receptor Antagonist/Hydrochlorothiazide Formulary Teveten HCT --> Restricted to NO SUB orders.
eravacycline	Xerava --> restricted to ID. Policy for Systemic Antibiotics for the Treatment of Carbapenem-Resistant Gram-Negative Bacterial Infections in ADULTS
ergocalciferol	Vitamin D Interchange Program Vitamin D2 Liquid --> No Sub orders if concentrated liquid is required
erlotinib	Tarceva --> Restricted to oncology. Anti-Neoplastic Formulary
esomeprazole	Huntsville Hospital Proton Pump Inhibitor Formulary
estazolam	Benzodiazepine-Related Hypnotic Formulary Prosom --> Restricted to NO SUB orders.
estradiol-norethindrone	Activella --> Restricted to use other than contraception.
eszopiclone	Lunesta --> Restricted to continuation of therapy. Benzodiazepine-Related Hypnotic Formulary
ethacrynic acid	Loop Diuretic Formulary
ethinyl estradiol-norgestrel	Restricted to use other than contraception.
ethyl chloride topical	Ethyl Chloride --> Restricted to Pediatric ED, Main ED, and Madison ED.
etodolac	NSAID Formulary Lodine--> Restricted to NO SUB orders.
factor IX complex	Miscellaneous Programs Patients with Factor IX deficiency due to hemophilia B. Profilnine (or Profilnine w/ NovoSeven) -- > restricted to patient on ECMO, previously received NovoSeven prior to PCC order, repeat PCC administration or no sub order.
fam-trastuzumab deruxtecan	Anti-Neoplastic Formulary
famotidine	Pepcid AC --> Restricted to NO SUB orders.
fecal microbiota transplant	---> ID and GI Miscellaneous Programs
felodipine	Calcium Channel Blocker (Dihydropyridine) Formulary Plendil --> Restricted to NO SUB ~OR~ if dose is higher than the listed interchange.
fenoprofen	NSAID Formulary Nalfon --> Restricted to NO SUB orders.
ferric carboxymaltose	Injectafer --> restricted to use in outpatient only in non-hemodialysis patients. IRON - Oral and IV Formulary
ferric citrate	Miscellaneous Programs Auryxia --> Restricted to NO SUB orders.
ferric derisomaltose	Iron - Oral and IV Formulary
ferrous fumarate	Iron - Oral and IV Formulary
ferumoxytol	Iron (Oral and IV) Formulary
fesoterodine	Anti-cholinergic (Overactive Bladder) Formulary Toviaz --> Restricted to NO SUB orders.
fibrinogen	RiaSTAP --> Restricted to Outpatient Medical ~OR~ use in pediatric patients for treatment of acute bleeding episodes due to congenital fibrinogen deficiency or fibrinogen depletion due to cancer, hepatic disease, chemotherapy, or hemorrhage. Miscellaneous Programs
fidaxomicin	Dificid --> Restricted to Infectious Disease or gastroenterologists Miscellaneous Program Formulary
filgrastim	Utilize most cost-effective agent
fish oil triglycerides	Omegaven --> is restricted to pediatric patients with direct or conjugated bilirubin level of 2 mg/dL or greater, and expected to be parenteral nutrition dependent for at least two weeks.
fluorine-18 florbetaben	Restricted to imaging
fluorine-18 florbetapir	Restricted to imaging
fluorine-18 flortaucipir
fluorine-18 flucicovine
fluorine-18 fludeoxyglucose	Restricted to imaging
fluorine-18 fluoroestradiol
fluorine-18 flutemetamol	Restricted to imaging
fluorine-18 sodium fluoride	Restricted to imaging
flurandrenolide topical	Corticosteroid - Topical
flurbiprofen	NSAID Formulary Ansaid --> Restricted to NO SUB orders
fluticasone	Corticosteroid (Inhaled) Formulary Flovent HFA, Flovent Diskus --> Restricted to ventilator patients.
fluticasone-salmeterol	Advair Diskus --> Restricted to NO SUB orders.
fluvastatin	HMG CoA Reductase Inhibitor Formulary Lescol --> Restricted to NO SUB orders.
formoterol-mometasone	Corticosteroids, Inhaled Formulary Dulera --> Restricted to pediatrics.
fosaprepitant	Emend for Injection --> Restricted to no sub oncology physician use. Miscellaneous Program Formulary
foscarnet	Miscellaneous Programs Foscavir --> restricted to infectious disease.
fosinopril	ACE Inhibitor Formulary Monopril --> Restricted to NO SUB orders ~OR~ dose higher than the listed interchange.
fosinopril-hydroCHLOROthiazide	ACE Inhibitor/Hydrochlorothiazide Combination Formulary Monopril HCT --> Restricted to NO SUB orders.
frovatriptan	Triptan Formulary
fulvestrant	Faslodex --> Restricted to Outpatient Medical. Anti-Neoplastic Formulary
gadobenate dimeglumine	Multihance --> Multihance is restricted to selected cardiac imaging studies and follow-up study where Multihance was the imaging agent originally used.
gadopiclenol	Miscellaneous Programs
gadoxetate	Eovist --> Restricted to MRI visualization of liver. Miscellaneous Programs
gallium-67 citrate	Restricted to imaging
gallium-68 dotatate
gallium-68 dotatoc
gallium-68 PSMA-11
gemtuzumab	Mylotarg --> inpatient use restricted to newly diagnosed CD33 positive AML patients receiving combination therapy induction or consolidation treatment.
glimepiride	Sulfonylureas Formulary Amaryl --> Restricted to NO SUB orders.
glucarpidase
glyBURIDE	Sulfonylureas Formulary Diabeta, Micronase --> Restricted to NO SUB orders.
glycopyrrolate	Cuvposa --> Restricted to pediatrics.
golimumab	Simponi Aria --> Restricted to Outpatient Medical. Each patient should be evaluated for reimbursement issues prior to starting. Miscellaneous Programs
goserelin	Zoladex-->Restricted to oncology specilaist in the outpatient setting for patients with advanced breast cancer. Anti-Neoplastic Formulary
guaiFENesin-codeine	Codeine is not to be used in children < 18 years old or in breastfeeding mothers. Contact MD for alternative therapy. Guaifenesin & DM/Codeine Combination Formulary
hepatitis B vaccine	Engerix B Pediatrics: restricted to patients that do not tolerated Recombivax HB Hepatitis B Vaccine Formulary
hexaminolevulinate	Miscellaneous
Human Chorionic Gonadatropin (hCG)	Miscellaneous
HYDROcodone-ibuprofen	Narcotic - Oral Formulary
hydrocortisone-polymyxin B otic	Otic Product Formulary
hydroxocobalamin	Miscellaneous Programs
hydroxychloroquine	Indications other than COVID-19
hylan G-F 20	Hyaluronic Acid Product Formulary Synvisc One --> Restricted to Outpatient Areas
hyoscyamine-methenamine	Methenamine Urinary Combinations Formulary Urisedamine --> restricted to NO SUB orders.
Hypochlorous acid 0.033%	Miscellaneous
ibandronate	Bisphosphonate Formulary Miscellaneous Program Formulary Boniva IV --> Restricted to Outpatient Medical.
ibuprofen	Caldolor --> limited to treat fever where IV ketorolac, oral and suppository forms of NSAIDS cannot be given or have proven ineffective.
idaruCIZUmab	Praxbind --> Restricted to patient situation meeting protocol.
idursulfase	Elaprase --> Restricted to approved cases. Contact memeber of the pharmacy management when ordered. Miscellaneous Programs
iloperidone	Fanapt --> restricted to continuation of home therapy.
iloprost	Ventavis --> Restricted to pulmonology, cardiology, and pediatric critical care. Miscellaneous Programs
imiglucerase	Contact member of pharmacy administration - must be evaluated for use on case-by-case basis Miscellaneous Program Formulary
imipenem-cilastatin	Carbapenem Formulary Primaxin IV --> Restricted to ID, Critical Care(i.e. Pulmonology, Trauma), ED, Pediatrics (Hospitalists, Oncology/St Jude, Critical Care) Primaxin IV --> Restricted to approved groups and NO SUB orders.
inclisiran	Miscellaneous
incobotulinum toxin A	Xeomin-->restricted to hospital outpatient setting Miscellaneous Programs
indium oxyquinoline In-111	Restricted to imaging
indium pentetate In-111	Restricted to imaging
indium pentetreotide In-111	Restricted to imaging
indium-111 capromab pendetide	Restricted to imaging
indium-111 chloride	Restricted to imaging
indomethacin	Indocin SR --> restricted to NO SUB orders.
inFLIXimab	Miscellaneous Program Formulary Inflectra/Remicade/Renflexis/Avsola --> Restricted to Outpatient, rare situations where inFLIXimab would be given pre-surgery for cases of ulcerative colitis or Crohn's disease, for a long-term inpatient who has not responded to other options, Inflectra/Remicade/Renflexis/Avsola --> Kawasaki Disease, or immunotherapy induced severe colitis unresponsive to high dose steroids.
inotuzumab ozogamicin	Besponsa --> Restricted to hospital outpatient setting (infusion centers, clinics) by oncology. Anti-Neoplastic Formulary
insulin degludec	Insulin Formulary
insulin detemir	Insulin Formulary Levemir-->restricted to pediatrics, pregnant patients, and NO SUB orders.
insulin glargine	Utilize most cost-effective agent.
insulin lispro	Utilize most cost-effective agent.
insulin regular	HumuLIN R KwikPen (Concentrated) --> restricted to continuation of home therapy.
iodine I-123 iobenguane	Restricted to imaging
iodine I-123 ioflupane	Restricted to imaging
iodine I-123 sodium iodide	Restricted to imaging
iodine I-125 human serum albumin	Restricted to imaging
iodine I-125 iothalamate	Restricted to imaging
iodine I-131 human serum albumin	Restricted to imaging
iodine I-131 sodium iodide	Restricted to imaging
ipilimumab	Yervoy --> Restricted to Outpatient Medical. Anti-Neoplastic Formulary
ipratropium	Atrovent HFA --> Restricted to NO SUB orders OR PRN orders kept at bedside or self-administered.
irbesartan	Angiotensin II Receptor Antagonist Formulary Avapro --> Restricted to NO SUB orders.
irbesartan-hydroCHLOROthiazide	Angiotensin II Receptor Antagonist/Hydrochlorothiazide Formulary Avalide --> Restricted to NO SUB orders.
irinotecan liposomal	Onivyde --> Restricted to Outpatient Medical Anti-Neoplastic Formulary
isatuximab-irfc	Anti-Neoplastic Formulary
isavuconazonium	Cresemba -- IV and PO are restricted to ID for use in immunocompromised patients for invasive fungal infection due to aspergillosis, mucormycosis, or if patient cannot tolerate/failed treatment with other agents.
isosorbide dinitrate	Isochron, Dilatrate-SR --> 40 mg extended release tablet restricted to NO SUB.
isosulfan blue	Lymphazurin --> Restricted to GYN/ONC specialists for use in vulvar cancer sentinel lymph node mapping. Miscellaneous Program Formulary
ixabepilone	Ixempra -- Restricted to Oncology. Anti-Neoplastic Formulary
ketoprofen	NSAID Formulary Orudis --> Restricted to NO SUB orders.
l-methylfolate	Deplin --> Restricted to initiation by psychiatry. Miscellaneous Programs Formulary
lactobacillus acidophilus	Probiotic Formulary Restricted to GI & Pediatric providers.
lactobacillus rhamnosus GG	Probiotic Formulary Restricted to GI & Pediatric providers.
lamoTRIgine	LaMICtal ODT --> Restricted to patients who cannot take the other dosage forms.
lanolin-mineral oil topical
lanreotide	Restricted to outpatient use.
lansoprazole	Huntsville Hospital Proton Pump Inhibitor Formulary Prevacid SoluTab --> Restricted to NO SUB orders, NG/G tube administration, ~OR~ Pediatrics. Prevacid DRC --> Restricted to NO SUB orders. FIRST Lansoprazole --> Pediatrics
lasmiditan	Miscellaneous Programs Reyvow --> restricted to neurology for therapy initiation when a triptan has failed or is not tolerated.
latanoprost-netarsudil ophthalmic	-> restricted to initiation by ophthalmology.
latanoprostene bunod ophthalmic	Vyzulta --> restricted to no sub.
leuprolide	Use in outpatient setting or indications listed below Miscellaneous
levalbuterol	Inhalation Drugs - Non-corticosteroids Formulary Xopenex HFA--> Restricted to NO SUB orders OR PRN order keep at bedside or self-administered Xopenex --> Restricted to NO SUB orders.
levobupivacaine	Chirocaine --> Restricted to use by Pain Center. Miscellaneous Programs
levodopa	Restricted to Pediatric Endocrinology.
LEVOleucovorin	Khapzory --> Restricted to shortage of leucovorin injection. Miscellaneous Program Formulary
levonorgestrel	Mirena --> Restricted to OB/GYN for treatment of dysfunctional uterine bleeding and menorrhagia.
levothyroxine	Ermeza --> restricted to pedatrics and adults when crushing tablets is not appropriate.
lidocaine-prilocaine topical	Miscellaneous Programs
lipid injectable emulsion	SMOFlipid --> Restricted to use in pediatrics. Miscellaneous Programs
lipiodol	Lipiodol --> Restriceted to use by interventional radiology for procedures approved by the FDA. Miscellaneous Program Formulary
lisinopril	Qbrelis --> restricted to pediatric patients.
loncastuximab tesirine-lpyl	Anti-Neoplastic Formulary
lopinavir-ritonavir	Severe/Confirmed COVID-19 or continuation of maitenance therapy.
loratadine	Claritin (syrup) --> Restricted to NO SUB orders.
lovastatin	HMG CoA Reductase Inhibitor Formulary Altoprev --> Restricted to NO SUB orders. Mevacor --> Restricted to NO SUB orders.
lumateperone	Psychiatric Formulary
lurbinectedin	Anti-Neoplastic Formulary
lutetium Lu 177 dotatate	Lutathera --> restricted to outpatient oncology.
lymphocyte immune globulin, anti-thy (equine)	Atgam --> Restricted to hematology/oncology and nephrology.
macitentan	Miscellaneous Programs Cardiologist, pulmonologists, rheumatologists and critical care prescribers enrolled in the REMS program
Margetuximab-cmkb	Anti-Neoplastic Formulary
measles/mumps/rubella virus vaccine, live	Vaccine Formulary
meclofenamate	NSAID Formulary Meclomen --> Restricted to NO SUB orders.
mefenamic acid	NSAID Formulary Ponstel --> Restricted to NO SUB orders.
meningococcal group B vaccine	Vaccines Formulary Trumenba --> Restricted to latex allergy, post-splenectomy patients or outpatients.
meperidine	Narcotic Liquids Formulary Demerol --> Restrictions below. Demerol (PCA) --> Restricted to when alternatives (morphine, DILAUDID, and fentaNYL) can not be used.
mepolizumab	Nucala --> Restricted to Outpatient Medical. Miscellaneous Programs
mercaptopurine	Anti-Neoplastic Formulary
meropenem	Restricted to ID, Critical Care(i.e. Pulmonology, Trauma), ED, Pediatrics (Hospitalists, Oncology/St Jude, Critical Care) Carbapenem Formulary
meropenem-vaborbactam	Carbapenem Formulary Vabomere --> Restricted to Infectious Disease for documented carbapenem resistant enterobacteriaceae (CRE) in cases where the patient has a severe penicillin or cephalosporin allergy or documented resistance to Avycaz. Policy for Systemic Antibiotics for the Treatment of Carbapenem-Resistant Gram-Negative Bacterial Infections in ADULTS
mesalamine	sfRowasa --> Restricted to patients who have sulfite/sulfur allergy ~OR~ are intolerant to regular mesalamine enema due to sulfite content.
methadone	methadone injection --> restricted to pediatric critical care,neonatology, and palliative care/hospice. Miscellaneous Programs
methenamine combination	Restricted to NO SUB orders.
methenamine mandelate-sodium acid phosphate	Uroquid-Acid No. 2 --> restricted to NO SUB orders.
methenamine-sodium biphosphate	Methenamine Urinary Combinations Formulary Uro-Phosphate -->restricted to NO SUB orders.
methenamine-sodium salicylate	Cystex --> Restricted to NO SUB orders.
methotrexate
methylnaltrexone	Relistor SubQ--> Restricted to use in the treatment of opioid induced constipation in adults. Miscellaneous Program Formulary
methylphenidate	Daytrana --> restricted to continuation of therapy.
methylphenidate_old	Daytrana --> restricted to continuation of therapy
metoclopramide	Metozolv ODT --> Restricted to patients that cannot take the tablet or solution and do not have an intravenous line.
midostaurin	Rydapt --> restricted to oncology for low income patients undergoing AML induction therapy, or in situations where outpatient supply would delay start date.
minocycline	Minocin IV --> Restricted to to ID physicians for use with multidrug resistant bacteria.
mirvetuximab soravtansine-gynx	Anti-Neoplastic Formulary
modafinil	Miscellaneous Program Formulary Provigil --> Restricted to NO SUB order
moexipril	ACE Inhibitor Formulary Univasc --> Restricted to NO SUB orders ~OR~ dose higher than the listed interchange.
moexipril-hydroCHLOROthiazide	ACE Inhibitor/Hydrochlorothiazide Combination Formulary Uniretic --> Restricted to NO SUB orders.
mogamulizumab-kpkc	Poteligeo --> restricted to outpatient oncology where at least one prior systemic therapy has failed.
molybdenum Mo-99 generator	Restricted to imaging
mometasone nasal	Intra-Nasal Steroids Formulary Nasonex --> Restricted to NO SUB orders ~OR~ dose higher than the listed interchange.
moxetumomab pasudotox-tdfk	Lumoxiti --> restricted to hospital outpatient oncology.
moxifloxacin	Quinolone Formulary Avelox --> Restricted to NO SUB orders.
mupirocin topical	Bactroban (cream) --> Restricted to NO SUB orders.
nadolol	Beta Blocker Formulary Corgard --> Restricted to NO SUB orders.
nafcillin	Nafcil oral capsule --> Restricted to NO SUB orders.
natalizumab	Miscellaneous Program Formulary
natamycin ophthalmic	Natacyn --> restricted to ophthalmology.
necitumumab	Portrazza --> restricted to Outpatient Medical. Anti-Neoplastic Formulary
nelarabine	Arranon --> Restricted to Outpatient Medical ~OR~ Approval by pharmacy admin for inpatient. Anti-Neoplastic Formulary
netarsudil ophthalmic	Rhopressa --> restricted to ophthamology for inpatient drug initiation.
niCARdipine	CarDENE SR --> Restricted to NO SUB order ~OR~ dose higher than the listed interchange.
nicotine	Nicotrol, ProStep (ER film) --> Restricted to NO SUB orders.
NIFEdipine	Adalat CC --> Restricted to NO SUB orders ~OR~ dose higher than the listed interchange.
nirmatrelvir-ritonavir	Miscellaneous
nirsevimab	Miscellaneous
nisoldipine	Calcium Channel Blocker (Dihydropyridine) Formulary Sular --> Restricted to NO SUB orders ~OR~ dose higher than the listed interchange.
nitazoxanide	Alinia --> Restricted to infectious disease and G.I. physicians. Miscellaneous Programs
nitric oxide	INOmax --> neonatal critical care, pediatric critical care, cardiology, pulmonology/medical-intensivist, and trauma physicians treating patients in an ICU.
nitrogen-13 ammonia	Restricted to imaging
nitrous oxide	Restricted to Labor and Delivery and ORs by anesthesiology and procedural sedation applications in Pediatric ED, HHM ED and Madison ED.
nivolumab	Opdivo --> Restricted to Outpatient Medical. Anti-Neoplastic Formulary
nivolumab-relatlimab	Anti-Neoplastic Drug Formulary
nizatidine	H2 - Receptor Blocker Formulary Miscellaneous Program Formulary Axid --> Restricted to NO SUB orders.
norethindrone	Aygestin --> restricted to use other than contraception.
norfloxacin	Quinolones Formulary Noroxin --> Restricted to NO SUB orders.
nystatin topical	Mycostatin Topical (ointment) --> Restricted to compounding.
obiltoxaximab	Miscellaneous Programs
obinutuzumab	Gazyva --> Restricted to Outpatient Medical. Anti-Neoplastic Formulary
ocrelizumab	Ocrevus --> Restricted to outpatient use by neurology. Miscellaneous Programs
octreotide	SandoSTATIN LAR Depot --> Restricted to Outpatient Medical.
ocular lubricant	Lacrisert --> Restricted to ICU situations where hospitalized patients are having to take frequent doses of lubricant eyedrops.
ofatumumab	Anti-Neoplastic Formulary
ofloxacin	Quinolones Formulary Floxin --> Restricted to NO SUB orders.
olaratumab	Lartruvo -- > Restricted to outpatient oncology. Anti-Neoplastic Formulary
olmesartan	Angiotensin II Receptor Antagonist Formulary Benicar --> Restricted to NO SUB orders.
olmesartan-hydroCHLOROthiazide	Angiotensin II Receptor Antagonist/Hydrochlorothiazide Formulary Benicar HCT --> Restricted to NO SUB orders.
omalizumab	Xolair --> Restricted to Outpatient Miscellaneous Program Formulary
omeprazole	Proton Pump Inhibitors Formulary
oprelvekin	Neumega --> Restricted to Hematology/Oncology. Miscellaneous Program Formulary Anti-Neoplastic Formulary
oritavancin	Miscellaneous
oxacillin	Penicillin - Penicillinase Resistant Formulary Bactocill --> Restricted to NO SUB orders.
oxaprozin	NSAID Formulary Daypro --> Restricted to NO SUB orders
oxazepam	Benzodiazepine Formulary Serax --> Restricted to NO SUB orders.
OXcarbazepine	Oxtellar XR --> Restricted to NO SUB orders.
oxybutynin	Oxytrol for Women --> Restrcited to NO SUB orders.
oxyCODONE	Oxydose, Oxyfast --> restricted to adult patients requiring at least 5 mg/dose and unable to tolerate volume of 1 mg/1mg solution.
PACLitaxel protein-bound	Abraxane --> Restricted to Oncology. Anti-Neoplastic Formulary
pafolacianine	Miscellaneous Formulary
palifermin	Kepivance --> Restricted to use by oncology for stem-cell transplant patients. Miscellaneous Program Formulary
palonosetron	Serotonin Receptor Antagonists (5-HT3)Formulary Aloxi capsule --> Restricted to NO SUB orders. Aloxi injection --> Restricted to Outpatient Medical.
pamidronate	Pamidronate and Zometa are formulary status, restricted, to be used by: oncology, nephrology, pneumatology, endocrinology. Pamidronate --> Restricted to
panitumumab	Anti-Neoplastic Formulary
pegaspargase	Oncaspar --> Restricted to oncology.
pegfilgrastim	Fulphila, Neulasta, Neulasta Onpro, Nyvepria, Udenyca, Ziextenzo, Fylnetra, Stimufend --> Restricted to hospital outpatient oncology.
peginterferon alfa-2b	Sylatron --> restricted to outpatient oncology.
pegloticase	Krystexxa --> restricted to rheumatology. If ordered for inpatient, investigate deferring to outpatient. Miscellaneous Programs
pembrolizumab	Anti-Neoplastic Formulary Keytruda --> Restricted to Outpatient Medical.
PEMEtrexed	Alimta --> Restricted to Oncology. Anti-Neoplastic Formulary
penbutolol	Interchange to pindolol Levatol --> Restricted to NO SUB orders.
penicillin G sodium	Miscellaneous Programs penicillin G sodium--> restricted to NO SUB orders or situations in which the physician or pharmacist identifies a clinical problem with the potassium product.
pentafluoropropane-tetrafluoroethane topical	Exceptions to this interchange program include: Pediatric ED, Main ED, and Madison ED.
peramivir	Rapivab --> Restricted to ID physician use; limited to patients with influenza who are not a candidate for enteral oseltamivir, cannot take inhaled zanamivir, and no suitable alternatives to intravenous therapy. Miscellaneous Programs
perampanel	Fycompa --> Restricted to initiation by neurology physicians. Miscellaneous Program Formulary
perflutren	Miscellaneous Programs
perindopril	ACE Inhibitor Formulary Aceon --> Restricted to NO SUB orders ~OR~ dose higher than the listed interchange.
pertuzumab	Perjeta --> restricted to outpatient oncology.
pertuzumab-trastuzumab-hyaluronidase-zzxf	Anti-Neoplastic Formulary
phenol	Miscellaneous Formulary
phenol topical	Miscellaneous
phentolamine	Regitine --> restricted during national shortage to hypertensive urgencies associated with catecholamine excess where other agents cannot be used (i.e. pheochromocytoma, amphetamine or MAOI overdose cases, clonidine withdrawal.) Miscellaneous Programs
pimavanserin	Initiation by a psychiatrist or neurologist Psychiatric Formulary
pitavastatin	HMG CoA Reductase Inhibitor Formulary
plecanatide	Trulance --> restricted to NO SUB orders.
plerixafor	Mozobil --> Restricted to Outpatient Medical and pharmacy administration approval. Miscellaneous Program Formulary
pneumococcal 13-valent conjugate vaccine	Vaccine Formulary
polidocanol	Asclera & Varithena --> Restricted to the THC Vein Treatment Center and Madison Hospital Vein Center. Miscellaneous Programs
polysaccharide-iron complex	NovaFerrum --> restricted to pediatrics.
poractant	Miscellaneous Programs Curosurf is restricted to neonatology.
posaconazole	ID & Oncology based on indication
potassium alum	Miscellaneous Formulary
PRALAtrexate	Folotyn --> Restricted to oncology. Anti-Neoplastic Formulary
prednicarbate topical	Corticosteroid (Topical) Formulary
promethazine-codeine	Codeine is not to be used in children < 18 years old. Contact MD for alternative therapy. Anti-tussive Liquid Combination Formulary
propofol	Propofol 2%(PROPOVEN) EUA Fact Sheet
prothrombin complex	Miscellaneous Programs Kcentra --> restricted to use for life-threatening bleeding or no sub. See below for approved prescribers.
quinapril	ACE Inhibitor Formulary Accupril --> Restricted to NO SUB orders ~OR~ dose higher than the listed interchange.
quinapril-hydroCHLOROthiazide	ACE Inhibitor/HCTZ Formulary Accuretic --> Restricted to NO SUB orders.
quiNINE	Limited to use for treatment of malaria Miscellaneous Program Formulary
RABEprazole	Huntsville Hospital Proton Pump Inhibitor Formulary
radium Ra 223 dichloride	Xofigo --> Restricted to Outpatient Medical. Anti-Neoplastic Formulary
ramelteon	Benzodiazepine-Related Hypnotic Formulary Rozerem --> Restricted to continuation of therapy.
ramucirumab	Cyramza --> Restricted to Oncology. Anti-Neoplastic Formulary
ranibizumab	Lucentis --> restricted to use by retina surgeons in ROP cases.
rasburicase	Elitek --> Restricted to oncology for use in hyperuricemia in patients who meet criteria for use. Miscellaneous Formulary
remdesivir	(5-day) Use criteria for Remdesivir (3-day) Short Course Remdesivir Criteria for Use Outpatient Short Course Remdesivir Criteria for Use Miscellaneous Programs
remifentanil	Miscellaneous Program Formulary Ultiva --> Pediatric restrictions: anesthesia during supinal cord fusion surgeries, critical care neurological patients requiring frequent neurological evaluations, critical care in patients with difficult airways who need to be extubated. Ultiva --> Restricted to anesthesiology for craniotomy.
reslizumab	Miscellaneous Programs
respiratory syncytial virus vaccine (RSV)	Vaccine Formulary
RHo (D) immune globulin	WinRho SDF --> restricted to need of higher doses in treatment of ITP.
rifapentine	Priftin --> restricted to ID for initiation. Miscellaneous Programs
rifAXIMin	Xifaxan --> Restricted to use by infectious disease, G.I. specialists or by UAB/Hospitalists (UAB/Hospitalist restricted to use after a 72 hour trial of lactulose or other frontline agent). Miscellaneous Program Formulary
riociguat	Miscellaneous Program Formulary
risankizumab	Miscellaneous Formulary
risperiDONE	RisperDAL M-Tab --> Restricted to patients unable to swallow an oral tablet.
riTUXimab	Utilize most cost-effective product for FDA-approved indications
riTUXimab-hyaluronidase	Rituxan Hycela --> restricted to outpatient oncology. Anti-Neoplastic Formulary
rizatriptan	Triptan Interchange Program Formulary Maxalt, Maxalt-MLT --> Restricted to NO SUB orders.
rolapitant	Varubi IV --> restricted to oncology for CINV and no sub orders. Anti-Neoplastic Formulary
romiDEPsin	Istodax --> Restricted to Oncology. Anti-Neoplastic Formulary
romiPLOStim	Nplate --> Restricted to hematology/oncology physicians. Miscellaneous Program Formulary
Romosozumab-aqqg	Miscellaneous Programs
rosuvastatin	HMG CoA Reductase Inhibitor Formulary Crestor --> Restricted to NO SUB orders. Ezallor Sprinkle--> Restricted to pediatric patients.
rubidium-82 chloride	Restricted to imaging
rufinamide	Banzel --> Restricted to initiation by neurology. Miscellaneous Program Formulary
sacituzumab govitecan	Anti-Neoplastic Formulary
samarium sm 153 lexidronam	Restricted to imaging
sarilumab	Miscellaneous Programs Covid 19 Criteria for Use
SARS-CoV-2 vaccine	Vaccine Formulary
selenium sulfide topical
sildenafil	Revatio --> Restricted to pulmonology, cardiology, rheumatology, and pediatric critical care for the treatment of pulmonary hypertension. Revatio IV --> Restricted to pulmonology, cardiology, rheumatology, or pediatric critical care. Miscellaneous Program Formulary
silodosin	Alpha-Blockers Formulary Rapaflo --> Restricted to NO SUB orders.
siltuximab	Miscellaneous Programs Covid 19 Criteria for Use
simvastatin	HMG CoA Reductase Inhibitor Formulary Zocor --> Restricted to NO SUB orders.
sirolimus
sodium benzoate-sodium phenylacetate	Ammonul --> Restricted to severe cases of hyperammonemia. Miscellaneous Programs
sodium chloride	23.4% - Neurosurgery, Neurology, Nephrology, Trauma Surgery and Adult & Pediatric Intensivists
sodium ferric gluconate complex	Iron - Oral and IV Formulary Ferrlecit --> Restricted to NO SUB orders.
solifenacin	Anti-cholinergic (Overactive Bladder) Formulary VESIcare --> Restricted to NO SUB orders.
sotrovimab	Miscellaneous Programs Sotrovimab Criteria For Use Prioritization of Sotrovimab
steven-Test	Descovy liquid restricted to peds
strontium-89 chloride	Restricted to imaging
sucroferric oxyhydroxide	Miscellaneous Programs Velphoro --> Restricted to NO SUB orders.
sugammadex	Bridion--> Anethesiology, Emergency Department, CV Surgery Miscellaneous Programs
sulfADIAZINE	sulfADIAZINE --> restricted to ID physician use for initiation. Miscellaneous Programs
suvorexant	Miscellaneous Programs Belsomra --> Restricted to the continuation of therapy.
tadalafil	Adcirca --> Restricted to initiation by pulmonology, cardiology, pediatric critical care, and rheumatology. Cialis --> Restricted to the treatment of BPH. Miscellaneous Program Formulary
tafasitamab	Anti-Neoplastic Formulary
tafluprost ophthalmic	Ophthalmic Prostaglandin Analogs Formulary Zioptan --> Restricted to NO SUB orders.
technetium-99m albumin aggregated	Restricted to imaging
technetium-99m bicisate	Restricted to imaging
technetium-99m disofenin	Restricted to imaging
technetium-99m exametazime	Restricted to imaging
technetium-99m mebrofenin	Restricted to imaging
technetium-99m medronate	Restricted to imaging
technetium-99m mertiatide	Restricted to imaging
technetium-99m oxidronate	Restricted to imaging
technetium-99m pentetate	Restricted to imaging
technetium-99m pyrophosphate	Restricted to imaging
technetium-99m red blood cell	Restricted to imaging
technetium-99m sestimibi	Restricted to imaging
technetium-99m sodium pertechnetate	Restricted to imaging
technetium-99m succimer	Restricted to imaging
technetium-99m sulfur colloid	Restricted to imaging
technetium-99m tetrofosmin	Restricted to imaging
technetium-99m tilmanocept	Restricted to imaging
tecovirimat	Miscellaneous
telavancin	Vibativ --> Restricted to infectious disease physicians. Miscellaneous Programs
telmisartan	Angiotensin II Receptor Antagonist Formulary Micardis --> Restricted to NO SUB orders.
telmisartan-hydroCHLOROthiazide	ARB Combination Products Formulary Micardis HCT --> Restricted to NO SUB orders.
temozolomide	Temodar --> Restricted to initiation by oncologist. Rarely Used Drugs and Expensive (RUDE)
temsirolimus	Torisel --> Restricted to Oncology. Anti-Neoplastic Formulary
tetanus/diphth/pertuss (Tdap) adult/adol	Adacel --> restricted to outpatient clinics.
thallium-201 chloride	Restricted to imaging
thrombin topical	Recothrom --> Restricted to use during national shortage of Thrombin-JMI.
ticlopidine	Miscellaneous Program Formulary Ticlid --> Restricted to NO SUB orders.
tildrakizumab	Ilumya -->restricted to hospital outpatient setting Miscellaneous Programs
timolol	Beta-Blocker Formulary Blocadren --> Restricted to NO SUB orders.
tinidazole	Tindamax --> Restricted to gastrointestinal and infectious disease specialists. Miscellaneous Program Formulary
tisotumab vedotin	Anti-Neoplastic Formulary
tocilizumab	Restricted to Outpatient Medical (for Non-COVID19/CRS). COVID-19 Criteria for Use Miscellaneous Programs
tofacitinib	In Setting of COVID-19
tolmetin	NSAID Formulary Tolectin --> Restricted to NO SUB orders
tolvaptan	Samsca --> Restricted to cardiology, endocrinology or nephrology physicians. Miscellaneous Program Formulary
tositumomab	Bexxar Dosimetric --> Restricted to Outpatient Medical. Anti-Neoplastic Formulary
traMADol	Narcotic - Oral Formulary Tramadol is not to be used in children < 18 years old or in breastfeeding mothers. Contact MD for alternative therapy.
trastuzumab	Herceptin, Herzuma, Kanjinti, Ogivri, Trazimera, Ontruzant --> restricted to outpatient oncology.
travoprost ophthalmic	Ophthalmic Prostaglandin Analog Formulary Travatan Z --> Restrcited to NO SUB orders.
treprostinil	Remodulin -> Miscellaneous Programs
triamcinolone nasal	Intra-Nasal Steroids Formulary Nasacort AQ --> Restricted to NO SUB orders ~OR~ dose higher than the listed interchange.
triamcinolone ophthalmic	Triesence --> Restricted to retina surgeons. Miscellaneous Programs
trilaciclib	Anti-Neoplastic
triptorelin	11.25 mg, 22.5 mg - Outpatient Therapy
trospium	Anti-cholinergic (Overactive Bladder) Formulary Sanctura XR --> Restricted to NO SUB orders.
ubrogepant	Miscellaneous Programs Ubrelvy --> restricted to neurology for therapy initiation when a triptan has failed.
unoprostone ophthalmic	Ophthalmic Prostaglandin Analogs-Drops Formulary Rescula --> Restricted to NO SUB orders.
uridine triacetate	Restricted to oncology Anti-Neoplastic Formulary
ustekinumab	Stelara --> Restricted to Outpatient Medical. Miscellaneous Program Formulary
vaccinia immune globulin, human	Miscellaneous
valrubicin	Valstar --> Restricted to Outpatient Medical. Anti-Neoplastic Formulary
vedolizumab	Entyvio --> Restricted to Outpatient Medical. Miscellaneous Programs
verteporfin	Visudyne --> Restricted to retina surgeons. Miscellaneous Program Formulary
vibegron	Miscellaneous Formulary
voriconazole	--> Suspension restricted to pediatric use in patients who cannot take or tolerate oral tablets.
vorinostat	Zolinza --> Restricted to Oncology. Anti-Neoplastic Formulary
xenon Xe-133	Restricted to imaging
yttrium-90 chloride	Restricted to imaging
yttrium-90 ibritumomab tiuxetan	Restricted to imaging
yttrium-90 microspheres	Restricted to imaging
zafirlukast	Leukotriene Formulary Accolate --> Restricted to NO SUB orders.
zaleplon	Benzodiazepine-Related Hypnotic Formulary Sonata --> Restricted to NO SUB orders.
ziconotide	Prialt --> Inpatient use restricted to continuation. Prialt --> Initiation restricted to Outpatient Medical. Miscellaneous Programs
zileuton	Leukotriene Formulary Zyflo CR --> Restricted to NO SUB orders.
zinc oxide topical	Zinc Oxide --> Restricted to use in compounding.
ziv-aflibercept	Zaltrap --> restricted to outpatient oncology. Anti-Neoplastic Formulary
zoledronic acid	Reclast --> Restricted to Outpatient Medical. Zometa --> Restricted to use by: oncology, nephrology, rheumatology, endocrinology. Hospitalists limited to treatment of hypercalcemia of malignancy using the Powerplan
ZOLMitriptan
zonisamide
zoster vaccine recombinant, adjuvanted	Outpatient Only

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