Insulin detemir (Levemir) is removed from formulary and an interchange to glargine is approved.

Insulin aspart penfill (Novolog) with Echo pen is removed from formulary.  Insulin lispro (Kwikpen Jr) is now the formulary rapid acting insulin for pediatric patients at RCH and Unity.

Cangrelor (Kengreal) added to formulary with restrictions.  Ordering restricted to cardiologist approval only, for patients who are:

• Undergoing high-risk* PCI and unable to take oral antiplatelet medication. Once these patients have OG/NG tubes placed, oral antiplatelet medication may be administered andIV cangrelor must be discontinued; or
  
• Admitted with high-risk unstable coronary anatomy requiring urgent CABG. This includes patients transferred to Emanuel from other sites for CABG. 
  

Ceftolozane-tazobactam (Zerbaxa) added to formulary.

Ceftazidime-avibactam (Avycaz) reviewed and not added to formulary.

Meropenem-vaborbactam (Vabomere) reviewed and not added to formulary.

Imipenem-cilastatin-relebactam (Recarbrio) reviewed and not added to formulary.

Cefiderocol (Fetroja) reviewed and not added to formulary.

Arformoterol (Brovana) formulary restrictions added.  Drug only to be ordered by pulmonologist or with pulmonary consult and restricted to for indication of:

• Documented PIFR failure performed by Respiratory Therapist,
• Mechanically ventilated patients or BIPAP dependent, or
• Continuation of home therapy

Nivestym (Filgrastim-aafi) added to formulary

Bovine Thrombin (Thrombin-JMI) added to formulary

Injectable Lipid Emulsion (SMOFLIPID) added to formulary with restriction for use in 2-1 TPNs (neonates and infants) only.

Arformoterol (Brovana) formulary restriction criteria changed (see June for additional changes)

Levetiracetam IV loading dose rounding approved.  Loading doses less than 350 mg will be rounded by in Epic to a standard dose in mg or to standard vial size

Nefazodone: removed from formulary

Meperidine Oral Tablet removed from formulary

Betamethasone restriction/therapeutic interchange during shortage approved

Tocilizumab for COVID-19 restrictions for inpatient use.  See SBAR

Droperidol formulary restrictions amended.  Maximum dose for droperidol:

• Agitation: IM/IV: 5 mg (may repeat in 10-30 minutes with an additional 5 mg for a single dose not to exceed 10 mg total max dose not to exceed 20mg)
• Nausea/vomiting: IM/IV: 0.625 mg - 1.25 mg
• Acute migraine: IM/IV: 1.25 – 2.5 mg (max dose: 2.5 mg; consider alternative agents if response not achieved after 2.5 mg)
• Additionally: Consider an EKG within 2 hours of administration for doses greater than 2.5 mg
  

Allopurinol IV removed from formulary

Brinzolamide/Brimonidine (Simbrinza) added to formulary for intraoperative ophthalmic use

Mifepristone (Mifeprex) formulary restriction expanded to include clinics and providers registered in REMs program, including MFM clinics, OB clinics and inpatient setting.  (previous restriction to only OB/Gyn providers that have registered in the REMs program)

Patiromer (Veltassa) reviewed and not added to formulary

Mitomycin (Mitosol Kit) added to formulary for topical administration in ophthalmic surgery in lieu of pharmacy prepared doses.

Tenecteplase added to formulary with restriction for indication:
  (1) Acute ischemic stroke as replacement for alteplase with following criteria:

• Patient has a diagnosis of acute ischemic stroke causing a neurological deficit and is 18 years of age or older
• Time of symptom onset is within 4.5 hours of treatment
• Recommended dose of 0.25 mg/kg (max dose: 25 mg) as a single bolus
• No contraindications to thrombolytic therapy are present

  (2) STEMI
  Remains non-formulary for treatment of pulmonary embolism.

Rituximab-pvvr (Ruxience) added to formulary as the preferred agent for inpatient use. Outpatient selection is based on insurance preference/formulary.

Epoetin Alfa-epbx (Retacrit) added to formulary as the preferred agent for inpatient use. Outpatient selection is based on insurance preference/formulary.

Esketamine (Spravato) added to formulary.  Restricted to use at Unity with insurance pre-approval.  Can continue patient own medication in hospital if patient is admitted on medication through patient own controlled medication process.

Remdesivir added to formulary.  Restriction to use with ID consult/approval for ordering between 8am and 5pm.

Arformoterol (Brovana)    added to formulary. Restricted to use in ICU/IMCU for patients where a breath actualized vehicle is not appropriate OR when patient comes into hospital on medication as continuation of home therapy.

Diazepam rectal kit (Diastat) removed from formulary    

Hepatitis B Vaccine (Heplisav) added to outpatient formulary. Restricted to adult outpatient use for patients at high risk for hepatitis B infection or non-responders to other hepatitis B vaccine formulation. Remain non-formulary for inpatient

Fluoride removed from formulary    

Nafcillin and piperacillin-tazobactam (Zosyn) removed from formulary

Oxacillin added to formulary

Biotin added to formulary for rule out or diagnosis of biotinidase deficiency. Restricted to Natrol and Medisca manufacturers only

Creatine added to formulary for rule out or diagnosis of cerebral creatine deficiency syndromes. Restricted to Medisca manufacturer only

Coenzyme Q10 added to formulary for rule out or diagnosis of a mitochondrial disorder. Restricted to NatureMade manufacturer only

N-acetylcysteine oral capsules added to formulary for behavioral health augmentation for marijuana abuse, skin picking, OCD, depression, bipolar disorder, or schizophrenia. Restricted to Nature’s Blend manufacturer only

Alemtuzumab added to outpatient formulary. Restricted to infusion clinic administration with REMS enrollment

Glucarpidase added to formulary. Ordering restricted to hematology, oncology, stem cell transplant, or pediatric attending

Bacitracin injection removed from formulary

Cannabidiol (Epidiolex) added to formulary with ordering restrictions.  Ordering restricted to neurology and requires concurrent approval from case management. No restrictions based on age.

Aminolevulinic acid (Gleolan) added to formulary with ordering restricted to providers who have completed the FDA-mandated neuro-surgeon training program.

Lissamine Green added to formulary
    
Isolyte A added to formulary, replacing non-formulary agent Plasmalyte A

Belbuca and Buprenorphine/Naloxone (Suboxone) film (Buprenorphine Film Products) added to formulary

Aprepitant (Emend) formulary restriction expanded to include one-time pre-operative dose for bariatric surgery patients only. Use for all other PONV remains restricted.

Brilliant Blue was added to formulary for ophthalmic use

Benzarlizumab (Fasenra) added to formulary with restriction to outpatient use in pulmonary clinic or infusion clinics and prescribing by pulmonologists or ANP only

Cariprazine (Vrylar) added to formulary

IV ibuprofen restriction criteria changed to 1 dose pre-operatively for LGS colorectal surgery patients

Source of misoprostol suppositories have become unavailable in Oregon; change to misoprostol tablets by sublingual, oral, or rectal route

Andexanet Alpha (Andexxa) was reviewed and not added to formulary.

Sodium Zirconium Cyclosilicate (Lokelma) was reviewed and not added to formulary.

Urea (Ure-Na) added to formulary.

Baloxavir was reviewed and not added to formulary.

Edoxaban was reviewed and not added to formulary.

Rasburicase dose limits approved as follows:

• Adults: one-time fixed 3 mg dose
• Pediatric: dose of 0.15 mg/kg/dose (max: 3 mg) based on the dosing table. […in SBAR…]
• Ordering restricted to order set including labs and the approved dosing based on patient age and/or weight.
• In the event a single dose is not sufficient, a repeat dose may be given if the uric acid level remains ≥8 mg/dL ≥ 24 hours after initial rasburicase dose and hydration or there is a rapid decline in patient condition due to TLS.
  
• See SBAR for more information

Approved addition of pulmonary hypertension medications (treprostinil, selexipag, ambrisentan, macitentan and riociguat) to the LH Formulary with restriction to continuation of home therapy when ordered through the pulmonary hypertension add-on order set.

Exparel (bupivacaine liposome) indication expanded to all shoulder surgery

Inhaled Corticosteroid Drug review:
- Keep Advair and Flovent HFA, and Budesonide on formulary
- REMOVE Flovent Diskus, Asmanex Twisthaler, and Symbicort HFA from formulary
- Do not add ArmonAir and Airduo

REMOVAL from formulary:
  - Combivent Respimat
  - Nesiritide
  - Fenoldopam
  - Tenecteplase
  - Lindane (Kwell) lotion and shampoo
  - DermOtic Oil (fluocinolone acetonide for the ear)
  - Betamethasone valerate foam
  - Erythromycin wipes/swabs. 

Inflectra (infliximab dyyb) added to inpatient formulary and removed Remicade (infliximab). (Remicade may be available in outpatient clinics as insurance allows).

Exparel (bupivacaine liposome) reviewed for formulary expansion, no additional usage or indications approved.

Kyleena approved for formulary

Skyla REMOVED from formulary

Betrixaban NOT added to formulary

Solithromycin NOT added to formulary

Delafloxacin NOT added to formulary

Berinert (complement C1 esterase inhibitor) remains formulary agent if choice for patients with hereditary angioedema (HAE). Non-formulary for ACE-I induced angioedema.

Ecallantide (Kalbitor) NOT added to formulary

Icatibant (Firazyr) NOT added to formulary

Valbenazine (Ingrezza) NOT added to formulary

Deutetrabenazine (Austedo) NOT added to formulary

Hydroxyprogesterone review: Makena product only formulary with exception for compounded product for allergy to any component of FDA approved product

Buprenorphine transdermal system (Butrans) review: status as NON-formulary

Levonorgestrel-releasing intrauterine system (IUS) review: Approved formulary addition of Liletta for 340b clinics and NON-formulary status for Kyleena.

Review of hyaluronate products:
Restriction of Euflexxa and Synvisc to orthopedic indication.  
Restriction of Duovisc, Provisc, Viscoat, Healon, Healon 5 to for ophthalmic indications. Pending approval via electronic voting (as of 3/30/17)

Nusinersen (Spinraza) review: Added to formulary with restriction to use only at Randall Children's Hospital by neurology, pulmonary, and physiatry providers

Multiple medications approved with restriction to outpatient and infusion clinic only (for Clark County Cancer Collaborative): Belimumab, Carfilzomib, Degarelix, Golimumab, Ipilimumab, Mepolizumab, Nivolumab, Olaparib, Omalizumab, Pembrolizumab, Pertuzumab, Ramucirumab, Tocilizumab, Trabectedin, Vedolizumab