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Following is a P and T Committee update (from the January 23rd meeting). Starting date for specific programs is 1 February 2018, unless otherwise noted. Please let me know if you have any questions or comments. Don’t forget to check the “New Drug Monitoring Spotlight” section of the website, which provides important monitoring information about newly approved drugs. Also, attached is the updated version of the “Not Stocked, Not Ordered” drug list with the new additions highlighted in red.
Below is the memo with links to the drug monographs, protocols, and formulary documents. Click to access the full P&T packet for this month, or here to access the P&T packet archive.
|
Drug or Drug Class |
Formulary Decision |
Comments |
| enasidenib (Idhifa) | Non-Formulary. |
Non-Formulary. Initiation should be deferred until after hospital discharge. Inpatients may use their own supply. |
| neratinib (Nerlynx) | Non-Formulary. |
Non-Formulary. Initiation should be deferred until after hospital discharge. Inpatients may use their own supply. |
| inotuzumab ozogamicin (Besponsa) | Formulary, Restricted |
Restricted to use by oncology in outpatient infusion areas. Not routinely stocked. |
| DAUNOrubicin-cytarabine liposomal (Vyxeos) | Referrred to High Value Committee. |
Recommendation is to restrict to use by oncology. Inpatient therapy is recommended for induction phase due to potential for tumor lysis phase, and need for strict monitor-ing and transfusions. May also be utilized in consolidation phase for inpatients and outpatients. Referred to High Value Committee for review, an inpatient cycle (3 doses) costs around $46,000. |
| RiTUXimab-hyaluronidase (Rituxan Hycela) | Formulary, Restricted |
Restricted to use by oncology in outpatient infusion areas and clinics. Patient should be monitored post-dose for signs of adverse drug reactions. Not routinely stocked. |
| copanlisib (Aliqopa) | Formulary, Restricted |
Restricted to use by oncology in outpatient infusion areas. Not routinely stocked. |
| rolapitant (Varubi) |
IV: Formulary, Restricted Therapeutic Equivalent to Emend IV
PO: Non-Formulary |
Varubi IV was restricted to use by oncology for chemotherapy induced nausea/vomiting, for use only with a no substitution order. The Committee also designated Varubi IV 166.5 mg and Emend IV 150 mg as therapeutically equivalent, and Varubi IV should be interchanged to Emend IV unless “no sub” is written. Varbui PO was classified as non-formulary, not stocked, rare use expected. |
| Adult Agitation Order Set (Psychiatry) Update (Behavioral Health) | Update was approved |
Haloperidol IV options were omitted from the orderset. The combination of LORazepam and ziprasidone was limited to severely agitated cases. Implementation date to be announced. |
| ICU Severe Alcohol Withdrawal Protocol Pilot | New order set was approved. | Includes multidisciplinary orders for this situation, including RASS monitoring and step approach to benzodiazepine IV dosing, phenobarbital IV option also included, implementation date to be announced. |
| Meropenem Use Criteria | Updated criteria approved | MUE planned. |
| Calcium Replacement Protocol | Updated Protocol approved | Modified protocol for drug shortage management with IVPBs, implementation date to be announced. |
| IV Fluid Shortages | Criteria for pharmacists modifying IVFs in relationship to critical fluid shortages was approved, includes issues such as giving some drugs by other methods and not IVPB, automatically converting IVFs infusing at 45 mL/hr or less to saline lock if meets criteria, discontinuing IVF if patient taking adequate PO, and others. | These items were approved to enhance the pharmacists role in conserving IVFs with the critical IVF shortage. These issues will be evaluated by the MEC in early February and if approved, will be implemented at that time. There will be further education on these directives before implementation. Pharmacists will work with nurses and MDs on these directives. |
| IV Narcotic Shortages | Criteria for pharmacists modifying IV narcotic regimens in relationship to the impending severe parenteral narcotic shortages was approved, includes issues such as automatic IV to PO conversion per criteria, reducing doses to nearest lower vial size to reduce waste, promoting multimodal analgesia, and others. | These items were approved to enhance the pharmacists role in conserving parenteral narcotic supplies during the shortage period. These issues will be evaluated by MEC in early February, and if approved, will be implemented at that time. There will be further education on these directives before implementation. Pharmacists will work with nurses and MDs with these issues. |