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P&T Policy
Please use the following form to request a medication addition to the formulary. All forms may be emailed to Britney.Mellor@fmolhs.org
The following form should be used for outpatient non-formulary requests ONLY:
For pharmacy use only:
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2022 |
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February (System P&T) |
Kcentra will remain formulary with the following fixed dosing strategy
Idarucizumab (Praxbind) added to system formulary
Andexanet alfa (Andexxa) reviewed and NOT approved for formulary addition Drug Class Reviews
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January (System P&T) |
Oxacillin added to formulary, nafcillin removed from formulary. Meropenem dose buttons added in Epic Drug classes reviewed:
Calcitonin restriction criteria discussed and approved |
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2021 |
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| December |
Bupivacaine-meloxicam (Zynrelef) added to formulary Liposomal bupivacaine (Exparel) dosing and preparation guidelines reviewed The following pharmacy protocol updates were approved:
Meropenem will include a hard stop for prescribers to select an indication button in Epic Methotrexate oral will default to a weekly frequency; daily frequency will require a hard stop in Epic to confirm an appropriate oncologic indication, per ISMP Best Practices Request to restrict injectable promethazine to PACU, ED, and Oncology ordersets only, per ISMP Best Practices, was NOT approved |
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December (System P&T) |
Ubrogepant (Ubrelvy) reviewed and NOT approved for formulary addition Appeals:
Drug classes reviewed:
Approved vaccine appeals:
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October (System P&T) |
Formulary addition request form presented and approved Ubrogepant (Ubrelvy) reviewed; approval pending further review Enfortumab vedotin (Padcev) reviewed and approved for outpatient use only Appeals:
Drug classes reviewed:
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October |
Enfortumab vedotin (Padcev) was reviewed and added to formulary, restricted to outpatient use only Avelumab (Bavencio) dosing updated to include 800 mg flat dose Inpatient pegfilgrastim MUE presented with no changes to formulary status or criteria for use. Consider annual MUE due to cost. Lanreotide 60 mg and 90 mg strengths added to formulary, restricted to outpatient use only approved by consent agenda |
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September (System P&T) |
Bupivacaine-collagen implant (Xaracoll) reviewed and added to formulary for FDA-approved indications only Prevnar-20 reviewed and approved as substitution for Prevnar-13 Pegfilgrastim-apgf (Nyvepria) reviewed and approved for outpatient use only Drug classes reviewed:
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August (System P&T) |
Aducanumab (Aduhelm) reviewed and NOT added to system formulary Following vaccine appeals were approved:
Therapeutic substitutions were presented and approved Drug classes reviewed:
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August |
Aducanumab (Aduhelm) reviewed and NOT added to OLOL formulary Pertuzumab, trastuzumab, and hyaluronidase (Phesgo) was reviewed and added to formulary, restricted to outpatient setting only Medication Samples in Provider-Based Clinics was reviewed and approved Vancomycin 6 month safety review was discussed Renal dosing policy and protocol were approved by consent agenda |
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July (System P&T) |
Ofirmev restriction approved:
Kayexalate oral appeal was made to expand restriction criteria to NPO in the pediatric population Zofran max dose was reduced from 32 mg to 16 mg in accordance with the FDA recommendations Drug classes reviewed:
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June (System P&T) |
Anavip approved as sole formulary antivenom Drug classes reviewed:
All oral antihyperglycemic medications will be removed from formulary except in the follow situations (see attached):
All inpatients, except those listed above will be converted to insulin therapy Oral Antihyperglycemic Conversion to Insulin Recommendations |
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June |
Cefepime added to outpatient formulary Respiratory formulary reviewed. Additions to respiratory formulary include:
Therapeutic interchange approved for Metamucil to Fibercon and mineral oil 300mL enema to mineral oil 266ml enema IV to PO Policy and Clozapine Policy reviewed and updated |
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May (System P&T) |
Drug classes reviewed:
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April |
Trastuzumab biosimilars reviewed. Ogivri approved as preferred agent for both inpatinent and outpatient settings (see Biosimilar and reference product interchange list) Ofirmev approved through the Improving Surgical Care and Recovery Pathway workgroups will be approved by the P&T committee via consent agenda moving forward Tacrolimus Pharmacy Monitoring Protocol approved. Start date TBD Restrictions removed from tranexamic acid. All formulations approved for formulary Alum 1% reviewed and NOT added to formulary Tafasitamab-cxix (Monjuvi) added to formulary, restricted to outpatient setting only |
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February |
Caplacizumab (Cablivi) added to formulary, restricted to hematology/oncology and nephrology Acetaminophen (Ofirmev) restriction expended to include Head & Neck ERAS Pegfilgrastim formulary status changed. Fulphila is inpatient formulary preferred agent. Added to inpatient formulary with following restriction criteria:
Filgrastim (Granix) formulary status changed. Granix is now preferred formulary agent. Lutetium Lu-177 Dotate (Lutathera) process map approved. Formulary changes specifically related to Lutathera include:
Tacrolimus medication use evaluation presented. Pharmacy to develop a monitoring protocol for presentation at April P&T meeting. |
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2020 |
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December |
Lipid emulsion (SMOF Lipid) added to formulary for expanded use in adults (previously only used in pediatrics) Carbidopa/Levodopa Extended Release (Rytary) added to formulary Infliximab-abda (Renflexis) added to formulary as the preferred inpatient and outpatient product Updated Biosimilar Protocol approved Updated Dose Rounding Protocol approved Updated Pharmacist Managed Warfarin Dosing Policy approved Daratumumab/hyaluronidase (Darzalex Faspro) added to forumlary and restircted to OUTPATIENT use only |
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October |
Moxifloxacin (Avalox) added to formulary and restricted to Critical Care/Pulmonology or Infectious Diseases physicians for the use in mycobacterial infections ONLY Exparel restriction criteria expanded to Head and Neck surgery Poractant alfa (Curosurf) added to formulary for use in the NICU ONLY Cannabidiol (Epidiolex) added to formulary at the Children's Hospital ONLY and restricted to continuation of home medication Sacituzumab govitecan-hziy (Trodelvy) added to formulary and restricted to OUTPATIENT use only Epoprostenol (Veletri) formulary interchange approved Crizanlizumab (Adakveo) added to formulary and restricted to OUTPATIENT use only Removed from formulary:
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August |
Meropenem/Vaborbactam (Vabomere) added to formulary and restricted to ordering by an Infectious Diseases provider Polatuzumab vedotin (Polivy) added to formulary Topical antifungals reviewed and formulary streamlined (Formweb updated) Updated Renal Dosing Protocol approved Updated Biosimilary Policy approved |
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June |
Addition of non-acetaminophen induced acute liver injury (NAI-ALI) added as an approved indication of intravenous acetylcysteine Truxima (rituximab-abbs) approved as the preferred inpatient and outpatient formulary agent for rituximab and rituxima biosimilars Updated Aminoglycoside Pharmacokinetic Protocol approved Updated Fomularly Management Policy approved Pharmacy to automatically monitor anti-Xa levels in morbidly obese patients approved Ultomiris added to formulary, restricted to outpatient only |
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February
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Eravacycline (Xerava) added to formulary and restricted to ordering by Critical Care providers for specific indications (see monograph on Formweb) and Infectious Disease providers Advate was deleted from formulary. Use Humate-P if factor VIII is needed Fixed-dose Kcentra approved for use in anti-Xa related life-threatening bleeding in addition to warfarin-related life-threatening bleeding Phenylephrine and ketorolac ophthalmic injection (Omidria) was not approved |
| 2019 | |
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December |
Blinatumomab (Blincyto) added to formulary and restricted to FDA approved indications of acute lymphoblastic leukemia (B-cell precursor) Heplisav-B added to formulary as preferred Hepatitis B vaccine Updated Vancomycin Pharmacokinetic Protocol approved Probiotic therapeutic interchange to Culterelle approved Acebutolol therapeutic interchange to atenolol approved |
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November (System P&T) |
IVIG dosing based on IBW or adj BW if patient is >20% above IBW was approved |
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October |
68ga-dotatate (NETSPOT) reviewed. Tabled for next meeting after review by oncology service-line committee Synthetic Human Secretin added to formulary Bevacizumab-awwb (Mvasi) added to formulary-restricted to new outpatient starts only Trastuzumab-anns (Kanjinti) added to formulary-restrictioned to outpatient only ANAVIP reviewed and added to formulary in addition to, not replacement for Crofab. Process to be developed for envenomations |
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August |
Liposomal daunorubicin and cytarabine (Vyxeos) added to formulary** Ceftolozane/tazobactam (Zerbaxa) added to formulary and restricted to ID provider for use in treatment of MDR Pseudomonas aeruginosa Ceftazidime/Avibactam (Avycaz) added to formulary and restricted to ID providers for the treatment of CRE and MDR Pseudomonas aeruginosa resistant to Zerbaxa Esketamine (Spravato) reviewed. Decision tabled until defined process is in place Cetuximab and Vectibix added to Medications Restricted to Outpatient List |
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June |
Sodium Zirconium Cyclosilicate (Lokelma) added to formulary Nebivolol (Bystolic) REMOVED from formulary. Therapeutic interchanged to atenolol |
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April |
Cangrelor (Kangreal) added to formulary. Restricted to interventional cardiology and only used in patients with no enteral access requiring emergency PCI Kcentra fixed dosing strategy for warfarin-related life threatening bleeding was approved |
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February |
Glucarpidase (Voraxaze) added to formulary with restrictions to inpatient use Meningococcal Group B Vaccine (Bexsero) added to formulary Perflutren Protein-Type A Microspheres (Optison) reviewed. Addition tabled Perampanel (Fycompa) reviewed and added for use only as a home medication, no new starts |
| 2018 |
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December |
Melatonin 3 mg and 5 mg ODT added to formulary Acetaminophen IV (Ofirmev) approved for use in colorectal surgery Belinostat (Beleodaq), Durvalumab (Imfinzi), Valrubicin (Valstar) approved for use in outpatient setting only |
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October |
ERAS Supplements, Kate Farms products, PediaSure Harvest, and KetoCal added to the Nutrition Care Formulary Andexanet alfa (Andexxa) added to formulary; has since been removed from formulary Glargine pen (Basaglar Pen) was reviewed and NOT added to formulary Rituximab/Hyaluronidase (Rituxan Hycela) and Aprepitant (Cinvanti) Injection added to formulary Removed from formulary: Buprenorphine 0.3 mg/1 ml; Buprenorphine/Naloxone 8 mg-2 mg film; Butabarbital Sodium 30 mg tab; Butorphanol spray; non-aerosol 10 mg/2.5 ml; Clonazepam disintegrating 0.125 mg tab; Fiorinal with Codeine capsule; Guaifen/Pseud 100 mg- 30 mg/5 ml syrup; Methohexital (Brevital) 500 mg inj; Morphine 30 mg capsule (Avinza); Oxycodone ER 80 mg tab; Pseudoephedrine ER 120 mg tablet; Pseudoephedrine 60 mg tablet |
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June |
CVT received approval for implementation of ERAS Protocol with 6 doses of Ofirmev permited to be given post-op if the first dose was given intra-op |
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April |
Removed from formulary:
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February |
Inflectra (infliximab-dybb) added to formulary |
| 2017 |
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December |
Infliximab-dyyb (Inflectra) reviewed Dantrolene (Ryanodex) reviewed |
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October |
Sodium, potassium, and magnesium sulfate (Suprep) added to the formulary Depocyte (liposomal cytarabine) REMOVED from formulary |
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September |
No medication changes |
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August |
Sacubitril/valsartan (Entresto) restriction expanded from Cardiology only to now include Internal Medicine/HMS for inpatient and outpatient utilization |
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June |
IV Prochlorperazine reviewed and added to formulary for the acute management of migraines in the ED for only 2 doses |
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April |
Nusinersen (Spinraza) reviewed and deferred to System P&T |
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February |
Veltassa approved for inpatient use and utilization to be reviewed in 6 months Nitroglycerin Sublingual Sprays REMOVED from formulary |
| 2016 |
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December |
No medication changes |
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October |
Venofer REMOVED from formulary |
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September |
Dexmedetomidine ordering privileges restricted to CCMS, LSU ICU, Trauma, CVT, ED, Anesthesiology |
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June
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Veltassa reviewed and NOT added to formulary Triamterent (Dyrenium) REMOVED from formulary IV-to PO Protocol: Cefdinir and Voriconazole added to Opportunities for Step-Down Therapy |
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April |
Sugammadex (Bridion) added to formulary for OR use only Veltassa reviewed and NOT added to formulary Removed from formulary:
Modifications of Dofetilide (Tikosyn) administration policy approved |
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March |
Lantus replaced Levemir as preferred long-acting insulin Methocarbamol added to the IV-to-PO drug list |
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February |
Clevidipine (Cleviprex) added to formulary Sucroferric oxyhydroxide (Velphoro) added to formulary
Sodium Tetradecyl Sulfate (Sotradecol) added to formulary with restrictions to severe bleeding secondary to esophageal varices that have failed other treatments IV Acetaminophen (Ofirmev) approved for use in Robotic Heart Surgery patients given in the following manner:
Ketamine Policy & Protocol: removed restriction from the location of palliative care patient Automatic IV-to-PO Protocol: Keppra(levetiracetam) and Vimpat(lacosamide) added |
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January |
Naloxogel (Movantik) added to formulary with restrictions to patients with opioid-induced constipation that have failed two or more laxatives
Belatacept (Nulojix) added to formulary with restrictions to outpatient use for EBV seropositive patients receiving a kidney transplant Idarucizumab (Praxbind) added to formulary |