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Following is a P and T Committee update (from the June 28th meeting). Starting date for specific programs is July 5, 2016, 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 |
| insulin degludec (Tresiba) |
Non-formulary Automatic Interchange Approved |
Orders for insulin degludec will be automatically interchanged to insulin glargine (Lantus) on a 1 unit : 1 unit dose ratio. Tresiba is only available as a 3 mL prefilled FlexTouch pen. |
| miglitol (Glyset) Update |
Reclassify as non-formulary Automatic interchange approved |
Miglitol is rarely used in the hospital. Automatically interchange miglitol orders to acarbose based on ordered regimen and patient weight. |
| phenoxybenzamine (Dibenzyline) Update |
Reclassify as non-formulary Automatic interchange approved |
Reclassified due to low use, increased cost, and wasted stock. Automatic interchange of phenoxybenzamine to doxazosin at an equivalent dosing regimen. |
| Alpha-Blocker Interchange Update | doxazosin – Formulary, restricted | Interchanged for phenoxybenzamine in rare cases of pheochromocytoma blood pressure control. Other doxazosin orders will continue to be interchanged to terazosin unless specified no substitution. |
| policocanol Injectable Foam (Varithena) | Formulary, restricted | Restricted to use by certified cardiologists in hospital outpatient area (Vein Center). |
| selexipag (Uptravi) | Non-formulary | Inpatients may use home supply. |
| naloxone Nasal Spray | Non-formulary | Onset of action is slower for the intranasal formulation. IV or IM routes are recommended in the acute care setting. |
| eluxadoline (Viberzi) | Formulary, restricted to continuation of maintenance therapy (home med) or initiation by GI specialist |
Continuation of a home medication may be ordered by any prescriber. Initiation of therapy during an inpatient stay is restricted to GI specialists. loperamide is an alternative therapy. |
| sebelipase alfa (Kanuma) | Non-formulary | Rare use is expected. |
| irinotecan liposomal Injection (Onivyde) | Formulary, restricted | Restricted to use by oncologists in outpatient settings. |
| Heparin Infusion MUE Update | Informational | MUE shows continued improvement in clinical use of heparin, will be highlighted as an improvement project for TJC. |
| Duplicate Medication Order Policy for Pharmacists | Policy approved |
Pharmacists may automatically discontinue previous medication orders from the EMAR if the order, utilizing the approved guidelines, is determined to be a duplication. Pharmacists may also clarify duplications of a select PRN medications and PRN indications. |
| Compounded Medication Policy Update | Policy revisions approved | Policy delineates the process for the approval, acquisition, and use of sterile products prepared by compounding pharmacies or outsourcing facilities outside of the Huntsville Hospital System. |
| Evaluation of External Compounding Facilities Policy Update | Policy revisions approved | The policy defines criteria for initial approval and annual evaluation of compounding pharmacies and outsourcing facilities. |
| Range Order Update | Policy revisions approved | Updates provide guidelines for the consistent interpretation of range medication orders and multi-route medication orders when specific instructions are not provided by the prescriber. |
| Titration / Tapering Policy Update | Policy revisions approved | Guidelines for continuous infusions of sedation agents were updated to include target RASS scores of -1 to 0 or based on parameters as determined by the prescriber. |