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Following is a P and T Committee update (from the August 28th meeting). Starting date for specific programs is 4 Sept 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 |
| angiotensin II (Giapreza) | Non-Formulary | Giapreza will continue to be evaluated as more complete literature supporting its safety and efficacy becomes available. |
| anti-inhibitor coagulant complex [activated prothrombin complex concentrate] (FEIBA) |
Formulary, Restricted
|
FEIBA will replace Kcentra as the preferred PCC product for anticoagulant associated bleeding following the same previously approved use restrictions. The Emergent Reversal of Oral Anticoagulants Order Set will be updated accordingly with standardized dosing of FEIBA (pending further institutional committee approvals). Use of FEIBA was also approved for control and prevention of bleeding episodes in patients with hemophilia. Kcentra & Profilnine remain on formulary for other uses (e.g. post CV surgery). |
| epoetin alfa-epbx (Retacrit) | Formulary Therapeutic Equivalent to Epogen, Procrit |
An automatic interchange among epoetin alfa agents based on economic considerations was approved. |
| pegfilgrastim-jmdb (Fulphila) |
Formulary, Restricted
|
The most economical agent in a given situation may be used based on cost and reimbursement considerations. Fulphila will not be used in place of Neulasta Onpro. |
| andexanet alfa (Andexxa) | Non-Formulary | Efficacy data is lacking. Huntsville Hospital has elected not to enroll in the Early Supply Program offered by the pharmaceutical company. Andexxa will continue to be evaluated as more complete literature supporting its efficacy and safety becomes available. |
| bictegravir-emtricitabine-tenofovir alafenamide (Biktarvy) |
Formulary
|
Not routinely stocked. Bictegravir is not currently available as an individual agent. Once bictegravir is available, Biktarvy will become non-formulary with an interchange to the individual agents dispensed separately. |
| lamiVUDine-tenofovir disoproxil fumarate (Cimduo) |
Non-Formulary
|
Individual components dispensed separately. |
| efavirenz-lamiVUDine-tenofovir disoproxil fumarate (Symfi & Symfi Lo) |
Non-Formulary
|
Individual components dispensed separately. |
| bupivacaine liposomal (Exparel) Cardiothoracic Surgery Pilot Results | Referred to High Value Care Committee | An MUE project was conducted on thoracotomy patients (n =17) who received either plain bupivacaine or Exparel. Both groups showed similar outcomes in all end points. Exparel use in cardiothoracic and other procedures will be reviewed by the HVCC. |
| BioDebridement Therapy Procedure Update | Policy & Procedure Approved | BioBag by BioMonde will be utilized for biodebridement maggot therapy. |
| Standardized 4 Safety (S4S) Initiative | Additions and Updated Concentrations Approved | amiodarone, cloNIDine, flecainide, riFAMpin, and ursodiol concentrations recommended by the Initiative were adopted at HHWC. The S4S initiative also recommends switching to commercially available suspensions and compounding kits when available [listed below]. |
| First Baclofen Suspension | Formulary | Commercially available product approved for use. Part of the Standardized 4 Safety FDA Initiative. |
| First Lansoprazole Suspension | Formulary, Restricted | Commercially available product approved for use. Restricted to use in small diameter enteral tubes that are easily occluded by formulary PPI preparations. Part of the Standardized 4 Safety FDA Initiative. |
| sildenafil (Revatio) Suspension | Formulary, Restricted | Commercially available product approved for use. Same restrictions as current Revatio formulations. Part of the Standardized 4 Safety FDA Initiative. |
| metroNIDAZOLE (Flagyl) Suspension | Formulary | Commercially available product approved for use. Part of the Standardized 4 Safety FDA Initiative. |
| Pediatric Dose Standardization Updates | Updates Approved | acetaminophen, aspirin, diphenhydrAMINE, ferrous sulfate, ibuprofen, lansoprazole, metoclopramide, ondansetron, promethazine, prednisoLONE, predniSONE, and raNITIdine were all evaluated. |