Approved Hospital Formulary
QR Code Add Formweb to your mobile device
Approved Hospital Formulary

Pharmacy & Therapeutics Committee – Meeting Minutes


·        May 2022

o   Post-splenectomy vaccines updated

o   Bezlotuxumab (Zinplava) restricted to outpatient

o   C. diff treatment guidelines updated

o   Cobicistat (Tybost) added to formulary with restrictions

o   Anifrolumab-fnia (Saphnelo) restricted to outpatient

o   Pafolacianine (Cytalux) non-formulary

o   Olanzapine/samidorphan (Lybalvi) interchange approved

o   Azelastine nasal spray non-formulary for inpatient use

·        February 2022

o   Lantus to Semglee conversion approved

o   PCC (Kcentra) Dosing for DOAC reversal updated

o   SUP Discontinuation Protocol approved

·        December 2021

o   Remifentanil (Ultiva) added to formulary with restrictions

o   Aggrastat removed from formulary, eptifibitide (Integrilin) only IIb/IIIa inhibitor on formulary

·        October 2021

o   Aminolevulinic acid (Gleolan®) added to formulary with restrictions

o   Empagliflozin (Jardiance) – restriction criteria modified to remove the ejection fraction requirement

o   Albuterol-ipratropium (Combivent Respimat®) substitutions approved

o   Ivermectin restriction criteria approved

o   COVID-19 medications: automatic pharmacist interchange approved for tocilizumab/baricitinib based on product availability; also for bamlanivimab/etesevimab or casirivimab/imdevimab

·        August 2021

o   Crotalidae immune F(ab’)2-Equine (Anavip®) added to formulary; will remove Crofab

o   Eptinezumab (Vyepti®) added to formulary

o   Polidocanol injectable foam (Varithena®) added to formulary with restrictions

o   Venetoclax (Venclexta®) added to formulary with restrictions

o   Budesonide, glycopyrrolate, formoterol (Breztri®) interchange approved

o   Rituximab-arrx (Riabni®) biosimilar for Rituxan added to formulary

·        June 2021

o   Alteplase for stroke formulary status revised

o   Darbepoetin alfa (Aranesp®) formulary interchange

·        April 2021

o   Isosorbide dinatrate-hydralazine (BiDil) – removed from formulary; substitute individual components

o   Demeclocycline 150 mg – removed from formulary due to very low use and high cost; patients to use own supply

o   Droperidol – added to formulary with restrictions

o   Lurbinectedin (Zepzelca) – added to formulary with restrictions to outpatient setting

·        February 2021

o   Empagliflozin (Jardiance) – approved use criteria

o   Benazepril (Lotensin) – removed from formulary; interchange approved

o   Simvastatin (Zocor) – removed from formulary; interchange approved

o   Gemfibrozil (Lopid) – removed from formulary; interchange approved

·        December 2020

o   Tenecteplase (TNKase) – approved for AIS treatment (replacing alteplase)

o   Quinidine gluconate – removed from formulary (patients may use home supply)

o   Nebivolol – removed from formulary (patients may use home supply)

o   Nitrofurantoin macrocrystals (Macrodantin) – restricted to patients requiring med admin via feeding tube. Otherwise interchange to Macrobid.

o   Dehydrated alcohol – restrictions added

·        October 2020

o   Sodium zirconium cyclosilicate (Lokelma) - restrictions removed

o   Oritavancin (Orbactiv) - more restrictive approach adopted

o   Filgrastim-sndz (Zarxio) – biosimilar added to formulary

·        August 2020

o   Argatroban removed from formulary

o   New biosimilar additions (Nivestym, Renflexis, Zirabev)

o   Levalbuterol (Xopenex) added to formulary with restrictions

o   Levothyroxine (Synthroid) injection restriction criteria

o   Lurasidone (Latuda) added to formulary with restrictions

o   Vabomere restriction criteria updated

·        June 2020

o   Vaccine product changes: Vaqta à Havrix, Adacel à Boostrix, Acthib à Hiberix; usage criteria approved for Prevnar-13 and Engerix-B

o   Respiratory product changes: Utibron NeoHaler à Stiolto Respimat, Seebri NeoHaler à Spiriva Respimat

o   Sugammadex updated restriction criteria

o   Urea oral powder (Ure-Na) added to formulary with restrictions

o   Tolvaptan (Samsca) usage criteria updated

o   Levonorgestrel (Plan B) added to formulary with restriction criteria

·        December 2019

o   Revefenacin (Yupelri) to glycopyrrolate (Seebri) interchange approved

o   Aprepitant (Cinvanti) to fosaprepitant interchange approved

o   Hexaminolevulinate Hydrochloride (Cysview) approved with restrictions

o   Caplacizumab –yhdp (Cablivi) approved with restrictions

o   Sugammadex (Bridion) MUE reviewed

·        October 2019

o   SGLT2 Inhibitor Class Review, empagliflozin added to formulary

o   Rituximab biosimilars approved for substitution

o   Cyclosporine ophthalmic (Restasis) emulsion removed from formulary, approved substitute to artificial tear product

o   Fluconazole IV Dosing changed approved

o   HIT Ab Assay Ordering with 4T score calculation

o   Renal Dose Adjustment and Timeliness of Scheduled Medications policies reviewed

·        August 2019

o   Estrogen class review

o   Rectal products class review

o   Amitiza (lubiprostone) and Linzess (linaclotide) restrictions approved

o   Co-enzyme Q-10 (ubiquinone) capsule removed from formulary

o   Diclofenac potassium removed from formulary

o   Lokelma (sodium zirconium cyclosilicate) added to formulary

o   Mvasi (bevacizumab-awwb) added for outpatient use

o   Kanjinti (trastuzumab-anns) added for outpatient use

o   Digifab dosing guidelines

·        May 2019

o   Opthalmic anti-infectives class review

o   Formulary removals: chlorpheniramine, Hemocyte Plus, piroxicam, cabergoline, trimehobenzamide, oxandrolone, tolnaftate, NAC fuel

o   Vabomere/Avycaz formulary interchange

o   Panehmatin restriction criteria approved

·        February 2019

o   Ambulatory Care/chronic disease med class review (new substitutions and formulary removals)

o   Suboxone, Subutex added to formulary

o   Otic preparations reviewed

o   Biktarvy added to formulary

o   Cinvanti/Emend formulary interchange

o   Morphabond, Xtampza formulary interchange

·        August 2018

o   ACE Inhibitor substitutions approved

o   ARB substitutions approved

o   Statin substitutions approved

o   Removed from formulary – niacin, pindolol, colesevelam, felodipine, isradipine, disoldipine, edoxaban, sildenafil 25 mg, aliskiren, indapamide, conivaptan, vabomere, malarone, mefloquine, primaquine, interferon alfa-2b, fluorouracil topical, butorphanol pentazocine/naloxone, felbamate, tiagabine, oxazepam, triazolam, hetastarch

o   Respiratory formulary changes

o   Giapreza – added to formulary

o   Embeda interchange approved

·        November 2017

o   Portrazza® (necitumumab) – added to outpatient formulary

o   Rydapt® (midostaurin) – approved with restrictions

o   Elitek® (rasburicase) – approved order set to assist with dosing

o   Bevyxxa® (betrixaban) – not approved for formulary addition

o   GLP-1 receptor agonists – formulary interchange approved

o   Northera® (droxidopa) – not approved for formulary addition

o   Atenolol drug shortage – substitution to metoprolol approved if/when atenolol supply is depleted

·        August 2017

o   Ocrevus® (ocrelizumab) – added to outpatient formulary

o   Zinplava® (bezlotoxumab) – not added to formulary

o   Mivacron® (mivacurium) – MUE being prepared

o   Gazyva® (obinutuzumab) – added to outpatient formulary

o   Glycoprotein IIb/IIIa Inhibitors – Aggrastat added to formulary, Integrilin removed

o   HIV Antiretroviral Formulary Review – see formulary changes

·        April 2017

o   Sotalol IV – removed from formulary

o   Latuda® (lurasidone) – designated non-formulary

o   Invega® (paliperidone) – designated non-formulary

o   Relistor® (methylnaltrexone) – interchange approved for SC Relistor

·        February 2017

o   Tecentriq® (atezolizumab) – approved for outpatient use

o   Cetylev® (N-acetylcysteine) – interchange approved

o   Relistor® (methylnaltrexone) oral – interchange approved

o   Ophthalmic Glaucoma Agents Class Review – interchanges approved

o   Blood factor products for inherited bleeding disorders – approved

o   Specialty Pharmacy Medications – approved “non-formulary, specialty” process

·        October 2016

o   Entresto® - restrictions approved

o   Clevidipine® - removed from formulary

o   Nitroprusside – removed from formulary (limited supply maintained)

o   Oxybutynin IR and ER – added to formulary

o   Rexulti® - interchange approved

o   Phenazopyridine – interchange approved

o   DPP-4 – interchange approved

o   Entyvio® - approved for outpatient use only with restrictions

o   Inflectra® - approved for outpatient use only

·        August 2016

o   Respiratory meds – new interchanges approved

o   Bladder antimuscarinics class review

o   PPI for tube administration

o   Nucynta® (tapentadol) – substitution approved

o   Tresiba® (insulin degludec) – substitution approved

o   Briviact® (brivaracetam) – added with restrictions

o   Darzalex® (daratumumab) – added to formulary

·        April 2016

o   Kengreal® (cangrelor) – restrictions approved

o   Exparel® (liposomal bupivacaine) – removed from formulary

o   Veltassa® (patiromer) – not added to formulary

o   Movantik® (naloxegol) – added with restrictions

o   Bridion® (sugammadex) – added with restrictions (for use in surgery)

o   Opthalmic antihistamines – reviewed; new substitutions added

·        February 2016

o   Keytruda® - formulary non-stock

o   Blincyto® – formulary non-stock

o   Voraxaze® – formulary non-stock

o   Nucala® – outpatient infusion use only

o   Cresemba® - added to formulary (ID restriction)

·        November 2015

o   Orbactiv® - not added

o   Nexavar® - patient own use whenever possible

o   Specialty Pharmacy Medications process approved

o   Cimzi® – not approved for outpatient formulary

o   Praxbind® - added to formulary

o   High Dose Influenza Vaccine – approved for 2016-17 flu season

o   Fentanyl IV Use Restrictions – approved for palliative care use

o   Statin formulary interchange approved for Crestor®

o   Entresto monitoring criteria approved

o   Phosphate Binder Class Review – new agents not added to formulary (Velphoro®, Auryxia®)

·        August 2015

o   Afrezza® (inhaled insulin) interchange approved

o   Extended release morphine interchange approved

o   Entresto added to formulary

o   Kengreal® (cangrelor) added to formulary

o   Cyramza® (ramucirumab) added to outpatient formulary

o   Panhematin® (hemin) added to formulary

o   Dalvance® (dalbavancin) not added

o   GI Cocktail formulary interchange

o   Combigan formulary interchange

·        June 2015

o   Antitussive class review

o   Vitamin class review

o   Respiratory formulary interchange review

o   Nivolumab (Opdivo®) – added to outpatient formulary

o   Eculizumab (Soliris®) – protocol approved

o   C1 esterase inhibitor (Berinert®) – added to formulary

o   Vitam D analogues – formulary interchange approved

o   Symbyax – formulary interchange approved

o   Buprenorphine (Buprenex®) – removed from formulary

·        April 2015

o   Anti-fungal class review

o   EpiPen – removed from formulary

o   Endothelin receptor antagonist class review – not added

o   Zerbaxa® and Avycaz® - added with restrictions

o   Soliris – protocol to be developed

o   Toujeo® - interchange approved

·        February 2015

o   New inhaled corticosteroid interchange

o   Peramivir (Rapivab®) – added with restrictions

o   Pneumonia vaccine changes

o   Edoxaban (Savaysa®) – added

o   Denosumab (Prolia®) – restrictions not lifted

o   IV ibuprofen (Caldolor®) – approved for trial use with restrictions

o   Cisatracurium (Nimbex®) – added

o   IV acetaminophen (Ofirmev®) – removed from formulary

·        October 2014

o   Empagliflozin (Jardiance®) – not added

o   Extended release budesonide (Uceris®) – added

o   Crystalloid cardioplegia (Custodial HTK®) – approved for trial use

o   Fluid resuscitation – LR vs NS recommendations

o   Azithromycin/erythromycin IV – substitution approved

o   Testosterone replacement products removed

·        August 2014

o   Albiglutide (Tanzeum®) – not added

o   Tedizolid (Sivextro®) – substitution approved

o   Mometasone/formoterol (Dulera®) – substitution approved

o   Hydrocodone ER (Zohydro®) – substitution approved

o   Metronidazole & ciprofloxacin standardized dosing

·        June 2014

o   Remifentanil (Ultiva®) – added

o   Umeclidinium/vilanterol (Anoro Ellipta®) – added

o   Outpatient iron formulary changes

o   Memantine (Namenda XR®) – substitutions approved

·        April 2014

o   Dapagliflozin (Farxiga®) – not added to formulary

o   Obinutuzumab (Gazyva®) – added

o   Clevidipine (Cleviprex®) – added with restrictions

o   Creon 24 – added

o   Omega-3 (Vascepa® and Lovaza®) – substitutions approved

o   Changes to pharmacist ordering of lab values

o   Antimicrobial Surgical Prophylaxis – dose changes

o   C.diff therapy review by stewardship pharmacist

·        February 2014

o   Ofatumumab (Arzerra®) – added

o   Combivent® - substitute with Duoneb

o   Aclidinium (Tudorza®) – possible switch from Spiriva pending updated pricing contracts

o   Breo Ellipta® - substitute with Symbicort

o   Oseltamivir (Tamiflu®) – automatic 5-day stop

·        October 2013

o   Alogliptin (Nesina®) – substitute Januvia®

o   Dolutegravir (Tivicay®) added

o   Golimumab (Simponi Aria®) – added to outpt infusion formulary

o   Alpha-1 Proteinase Inhibitor (Aralast®, Prolastin®) – removed

o   Ado-trastuzumab (Kadcyla®) – added to formulary

o   Tbo-filgrastim (Granix®) – once available, will be substituted for filgrastim

·        August 2013

o   Tadalafil (Adcirca®) – substitute sildenafil

o   Silodosin (Rapaflo®) – substitute tamsulosin

o   Azilsartan (Edarbi®) added

o   C1 Inhibitor (Cinryze®) - new restrictions

o   Angiomax weight based protocol

o   Injectable iron changes

o   Rh(d) immune globulin changes

·        June 2013

o   Invokana® (canagliflozin) not added

o   Mesalamine substitution changes

o   Topical antiviral substitutions approved

o   Neupro® (rotigotine) added

o   Viibryd® (vilazodone) added

·        February 2013

o   Tolvaptan (Samsca®) – new restriction for new starts

o   Apixaban (Eliquis®) added

o   Linaclotide (Linzess®) added

o   Carfilzomib (Kyprolis®) added

o   Lansoprazole (Prevacid®) added for patients intolerant to pantoprazole

o   Liposomal bupivacaine (Exparel®) approved for trial use

o   Azithromycin (Zithromax®) 5 day automatic stop approved (with exceptions)

·        December 2012

o   Infliximab (Remicade®) new restriction for NEW orders

o   Tafluprost (Zioptan®) not added to formulary; sub Xalatan®

o   Mirabegron (Myrbetriq®) added

o   Romiplostim (Nplate®) added (restricted to Hematology)

o   Butorphanol nasal spray (Stadol NS®) removed

o   Penicilloyl polylysine (Pre-Pen®) added (restricted to ID)

·        October 2012

o   Lepirudan (Refludan) to argatroban interchange

o   Roflumilast (Daliresp®) added

o   Denosumab (Prolia®) restricted use defined

o   IVIG (Octagam®) approved

o   Sulphan Blue instead of isosulfan blue

o   Pred-G substituted for TobraDex

·        June 2012

o   Febuxostat (Uloric®) added

o   Fosfomycin (Monurol®) added

Pharmacy Phone Numbers
Memorial Pharmacy (Glenwood) 423-495-8380
Memorial Hixson Pharmacy 423-495-7137
Stat 423-495-7470
Outpatient 423-495-8981
Chemo 423-495-7475
Surgery 423-495-8779

This site is intended for the staff of Memorial Health Care System.
While others may view accessible pages, Memorial Health Care System makes no warranty, express or implied,
as to the use of this information outside of Memorial Health Care System.