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Pharmacy & Therapeutics Committee – Meeting Minutes
o Empagliflozin (Jardiance) restriction criteria updated
o Inclisiran (Leqvio) approved for outpatient use
o Methylene blue product change approved
o Topical benzocaine 20% spray added to formulary with restrictions
o Dexamethasone ophthalmic drops product change approved
o Bevacizumab-maly (Alymsys) added to formulary
o Guaifenesin with codeine antitussive liquid restricted to adults
o Methocarbamol (Robaxin) IV duration limit
o Eszopiclone (Lunesta) added to formulary with restrictions
o Levetiracetam (Keppra) doses of up to 1500 mg to be given as IV push.
o Vibegron (Gemtasa) interchange approved
o Electrolyte replacement guideline changes approved for potassium
o Hydralazine IV – default comments in Epic to hold for HR > 100
o Clinimix E – added to formulary to be used in place of custom TPN for certain patients
o Spesolimab-sbzo (Spevigo) – added to outpatient formulary with restrictions
o Aminolevulinic acid (Gleolan) – dose rounding approved
o Sulfadiazine – removed from formulary
o Acetaminophen with codeine oral liquid – removed from formulary
o Clinimix E approved to formulary (go live planned late March)
o Pantoprazole (Protonix) drips removed from formulary
o Removal of COVID vaccines from formulary
o Paxlovid use criteria updated
o New Botox alternative approved to formulary (incobotulinum toxin A)
o Sublingual dexmedetomidine (IGALMI) – designated non-formulary
o Hydralazine – hold instructions needed for heart rates exceeding 100 beats per minute
o IVIG – changing from Octagam to Privigen
o Ophthalmic non-anti-infective class review
o Iron product shortages – approved automatic conversion to iron sucrose (Venofer) when both sodium ferric gluconate and iron dextran are unavailable
o Bebtelovimab – no longer authorized for emergency use due to lack of efficacy against select Omicron sub-variants
o Posaconazole (Noxafil) – added to formulary with restrictions
o Ceftazidime/avibactam (Avycaz) – replaced Vabomere on formulary
o Ammonia smelling salts – removed from formulary
o Banana bag – removed from formulary
o Dexmedetomidine (Precedex) – taper approved
o Tecovirimat (Tpoxx) – added to formulary
o Pfizer-BioNTech COVID-19 bivalent booster vaccine – added to formulary
o Pentobarbital added to formulary with restrictions
o Hepatitis B vaccine product changes
o Tezepelumab (Tezspire) added to formulary with restrictions
o Inclisiran (Leqvio) designated non-formulary
o Paricalcitol (Zemplar) designated non-formulary
o Anavip replacing CroFab
o Promethazine (Phenergan) IV restrictions
· 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
o Lantus to Semglee conversion approved
o PCC (Kcentra) Dosing for DOAC reversal updated
o SUP Discontinuation Protocol approved
o Remifentanil (Ultiva) added to formulary with restrictions
o Aggrastat removed from formulary, eptifibitide (Integrilin) only IIb/IIIa inhibitor on formulary
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
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
o Alteplase for stroke formulary status revised
o Darbepoetin alfa (Aranesp®) formulary interchange
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
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
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
o Sodium zirconium cyclosilicate (Lokelma) - restrictions removed
o Oritavancin (Orbactiv) - more restrictive approach adopted
o Filgrastim-sndz (Zarxio) – biosimilar added to formulary
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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)
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®)
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
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
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
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
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
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
o Remifentanil (Ultiva®) – added
o Umeclidinium/vilanterol (Anoro Ellipta®) – added
o Outpatient iron formulary changes
o Memantine (Namenda XR®) – substitutions approved
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
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
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
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
o Invokana® (canagliflozin) not added
o Mesalamine substitution changes
o Topical antiviral substitutions approved
o Neupro® (rotigotine) added
o Viibryd® (vilazodone) added
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)
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)
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
o Febuxostat (Uloric®) added
o Fosfomycin (Monurol®) added