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Following is a P and T Committee update (from the March 28th meeting). Starting date for specific programs is 3 April 2017, 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.
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Drug or Drug Class |
Formulary Decision |
Comments |
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Formulary, Restricted Approved as a therapeutic equivalent to Remicade, will use most cost effective agent at any given time, or for a certain patient. For pediatric ulcerative colitis cases, Remicade will be used until this use receives FDA approval. |
Restricted to outpatient use, and inpatient use in 2 unusual situations:
Implementation date to be announced, OPM education planned. |
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Formulary, Restricted
Required order set approved |
Restricted to 6 physician groups for emergent reversal of warfarin or oral direct factor Xa inhibitor induced serious bleeding in adults, or for those adults on these anticoagulants requiring emergent surgery. Protocol required for use. Implementation pending availability of protocol. |
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Formulary, Restricted Therapeutic interchange to Kcentra unless contraindications to Kcentra or on ECMO Updated required order set approved |
Restricted to 6 physician groups for patients with serious anticoagulant bleed and history of HIT or allergy to albumin, or on ECMO. Updated order set required for use. |
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Formulary, Restricted
Order set for use in OPM approved.
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Restricted to outpatient use in non-hemodialysis patients. Currently more cost-effective in outpatient setting vs Feraheme. Venofer is the preferred drug for hemodialysis patients in the outpatient setting. Implementation pending availability of protocol. |
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Non-Formulary
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Contact MD for change to the formulary agent i.e. Injectafer |
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Huntsville Compounding 200 mg suppositories will continue to be used as main formulary agent. These are issued to the individual patient.
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Endometrin vaginal inserts classified as formulary, not routinely stocked. First Progesterone VGS 200 mg supp kit classified as non-formulary. |
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Non-Formulary |
OB physicians preferred use of suppositories |
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Formulary, not routinely stocked |
RhoPhylac is main formulary agent, WinRho can be ordered if larger dose vials are needed for rare use in ITP, RhoPhylac can be used until WinRho obtained within 24 hrs. |
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Anti-Infective Formulary Classification Updates |
Eight anti-infective agents, including Avycaz, Zerbaxa, Dalvance, and Tygacil were reclassified as formulary drugs with strict restrictions. |
Refer to each drug for specific restrictions. Most are not routinely stocked, but restricted to ID and can be obtained if needed for certain situations. |
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tranexamic acid in Shoulder Replacement Surgery |
Expanded Use Approved with Protocol |
Protocol updated to include 1 dose with shoulder replacement surgery, implementation pending availability of updated protocol |
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Humira First Dose Program Update |
Benefit verification process moved to physician office/nurse practitioner. Can begin new process now, updated protocol will be available in near future. Contact Richard or Adam if any questions. |
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telavancin (Vibativ) Dose Rounding |
Dose Rounding Program Approved |
Round off to nearest 50 mg dose, to be implemented in ICare. |
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CRRT Anti-Infective Dosing Update |
Dosing Adjustments Approved |
Adjustments for dosing of ceftolozane-tazobactam and doripenem in CVVH and CVVHD were updated to reflect new information in the medical literature. |
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Informational |
The 2016 antibiogram is now available. Can be accessed from the Pulse Page--> Departments--> Operations I --> Pharmacy/Drug Info --> Antimicrobial Stewardship --> Antibiograms. Both Historical and 2016 can be found here. |
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Formulary, Automatic Interchange for drug shortage situation |
The 1,000 mg/ 62.5 mg tablet will be interchanged to the 875 mg/ 125 mg tablet. |
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promethazine inj is new shortage, also includes bicillin/procaine penicillin, methylene blue 1% inj. , albuterol 0.5% neb sol’n, and others. |
Continue to monitor supplies and availability. Methylene blue 0.5% inj. Is available. Interchange promethazine inj. to prochlorperazine inj. |
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ADEs |
insulin, vancomycin, and levofloxacin are the drugs most frequently identified as causative agents in the reports received. |
Insulin accounted for almost half of the 15 preventable ADEs reported. |