Acadiana Market P&T - 2025

LOHH, LOWC, LOLR

Formulary Clarification:

• Potassium replacement formulation clarification
• FMOLHS Vaccine List - RefreshedFormulary Appeal:

Formulary Appeal:

• Uzedy (risperidone extended release injectable)
• Ingrezza (valbenazine)
• Austedo (deutetrabenazine)
• Caplyta (lumateperone)
• Vraylar (cariprazine)
• Trintellix (vortioxetine)
• Viibryd (vilazodone)

Formulary Requests:
Tarlatamab-dlle (Imdelltra)
Cetirizine IV (Quzyttir)  
Fenfluramine (Fintepla)  
Sulbactam/durlobactam (XACDURO)
Glofitamab-gxbm (Columvi)

Formulary Modification:
Promethazine Injectable

Consent Agenda (previously reviewed)

• Analgesics and Antipyretics, Misc (28:08.92)
• Antilipemic Agents (24:06.05) (24:06.92)
• Antithyroid Agents (63:36.08)
• Cardiac Drugs, Misc (24:04.92)
• Estrogens, Part 1
• Estrogens, Part 2
• Estrogens, Part 3
• Hepatitis C Virus (HCV) Inhibitors (8:18.40.20, 8:18.40.24, 8:18.40.16)
• NSAIDs (28:08.04)
• Opiate Agonists (28:08.08)
• Opiate Partial Agonists (28:08.12)
• Plasma Volume Expanders (16:00, 40:12)
• Probiotics (lactobacillus rhamnosus GG and Bifidobacterium-lactobacillus)
• Progestins, Rifamycins (8:12.28.30) (8:16.04)
• Rifamycins (8:12.28.30) (8:16.04)
• Second Generation, Antihistamines (4:08)
• Sulfonylureas (68:20.20)
• Thiazolidinediones (68:20.28)
• Vasopressin Antagonists (40:28.28)
• Vitamin D analogs
• Androgens, Part 1 (68:08)
• Androgens, Part 2 (68:08)
• Antimalarial Agents (8:30.08)
• Antineoplastic, immunosuppressant (10:00)
• Calcineurin inhibitor immunosuppressant agent (92:44)
• Coumarin Derivatives (20:12.04.08)
• Direct Acting skeletal muscle relaxants (12:20.081)
• Direct Thrombin Inhibitors (20:12.04.12)
• Direct Vasodilators (24:08.20)
• Hydroxyzine formulations
• LMWHs (20:12.04.16)
• Mycophenolate (92.44)
• Ophthalmic Agents: Antivirals (52:04.20)
• Prokinetic Agents (56:32) Metoclopramide monograph
• Protectants (56:28.32) sucralfate monograph
• Sclerosing Agents (24:16, 84:04.08.20)
• Selective Beta-1-Adrenergic Agonists (12:12.08.08)
• Skeletal muscle relaxants, Part 1 (12:20.04)
• Skeletal muscle relaxants, Part 2 (12:20.12, 12:20.04, 12:20.92)
• Sodium-glucose cotransporter 2 (SGLT2) Inhibitors (68:20.18)
• Vitamins (Part 1)
• Vitamins (Part 2)
• Lencapavir (Yeztugo) Injection
• Biosimilar Review 
• Denosumab, biosimilars, Part 1 (90:16) 
• Denosumab, biosimilars, Part 2 (90:16) 
• Eculizumab, biosimilars (90:20) 
• Complement Inhibitors, C5 and C3 (92:21.08) 
• Anti-Sialorrhea Agents  
• Appetite Stimulants 
• Bevacizumab, biosimilars (10:00) 
• Calcineurin inhibitors, topical (84:92) 
• Caloric Agents - Fat Emulsions 
• Cyanokit (hydroxycobalamin) 
• Entry and Fusion Inhibitors (8:18.08)  
• Erythropoiesis stimulating agents, biosimilars (20:16) 
• Filgrastim, biosimilars (20:16) 
• Infliximab, biosimilars (92:36) 
• Appetite Stimulants 
• Ophthalmic Agents: Vasoconstrictors (52:32) 
• Otic Antimicrobials, Part 1 (52:04.04) 
• Otic Antimicrobials, Part 2 (52:04.04) 
• Pegfiltrastim, biosimilar (20:16) 
• Renin Inhibitors (24:32.40) Aliskerin Monograph 
• Rituximab, biosimilars (10:00) 
• Tocilizumab, biosimilars (92:36) 
• Trastuzumab, biosimilars (10:00) 
• Ustekinumab, biosimilars (92:36) 
• Fluoroquinolones (8:12.18) 
• Rifamycins (8:12.28.30) (8:16.04)

Antimicrobial Stewardship:
Policy Update: In addition to current policy, MRSA/MSSA Bacteremia, Fungemia, and Carbapenem resistance require an ID consult

Measurements:
Adverse Drug Reactions

Next meeting will be in December, off site
For details of the meeting, including class reviews and consent agenda, click here.

Formulary Appeal Request:

• Vutrisiran (Amvuttra) - Approved for treatment of transthyretin amyloidosis with cardiomyopathy (ATTR-CM) and hereditary transthyretin amyloidosis with polyneuropathy (hATTR-PN) in adults, including those unable to tolerate or that do not respond to current therapies 

Class Reviews: none

Consent Agenda (previously reviewed)

• Antigout Agents (92:16)(40:40)
• Antihelmintics (8:09)
• Antiparathyroid Agents (Calcimimetics)(68:24.20.04)
• Biguanides (68:20.04)
• DDP-4 Inhibitors (68:20.04)
• Dopamine (D2) Agonist, Ergot (28:36.20.04)
• Antihistamines, first generation (4:04)
• Guanylate Cyclase-C (GC-C) Agonists (56:92) 
• Insulins (68:20.08) 
• Iron replacement (oral) 
• Leukotriene Modifiers (48:10.24) 
• Lincosamide (8:12.28.20) 
• Macrolides (8:12.12) 
• Magnesium replacement products 
• Miotics, Ophthalmic (52:40.20) 
• Monobactam (8:12.07.16) 
• Mydriatics, Ophthalmic (52:24) 
• Phosphodiesterase-4 (PDE4) Inhibitors (92:36, 84:06.92, 84:92, 48:32) 
• Potassium replacement products (IV) 
• Potassium replacement products (oral) 
• Rabies Immune Globulin 
• RhoD Immune Globulin 
• Analgesics and Antipyretics, Misc (28:08.92) 
• Antilipemic Agents (24:06.05) (24:06.92) 
• Antithyroid Agents (63:36.08) 
• Cardiac Drugs, Misc (24:04.92) 
• Estrogens, Part 1 
• Estrogens, Part 2 
• Estrogens, Part 3 
• Hepatitis C Virus (HCV) Inhibitors (8:18.40.20, 8:18.40.24, 8:18.40.16) 
• NSAIDs (28:08.04) 
• Opiate Agonists (28:08.08) 
• Opiate Partial Agonists (28:08.12) 
• Plasma Volume Expanders (16:00, 40:12) 
• Probiotics (lactobacillus rhamnosus GG and Bifidobacterium-lactobacillus) 
• Progestins 
• Rifamycins (8:12.28.30) (8:16.04) 
• Second Generation 
• Antihistamines (4:08) 
• Sulfonylureas (68:20.20) 
• Thiazolidinediones (68:20.28) 
• Vasopressin Antagonists (40:28.28) 
• Vitamin D analogs

Antimicrobial Stewardship:
Usage presented for LOLR, LOHH, LOWC 
Antibiograms presented for adults and pediatrics 

Measurements:
Diversion – Quarterly review 
Discussion of Opioid Stewardship Program
Opioid Usage/Reversal 
BCMA Scanning by Facility 

For details of the meeting, including class reviews and consent agenda, click here.

Pharmacy Protocol Reviews:

• Automatic IV to PO Conversions
• Automatic IV to PO Conversion Equivalencies
• PPI-H2RA Duplicates
• Drug Dosing Protocols
       1. Renal Dosing Protocol
       2. Aminoglycoside Dosing Protocol
       3. Vancomycin Dosing Protocol

Formulary Appeal Request:

• Effient - approved with updated guidelines
• Crofab- will be formulary, along with Anavip

Formulary Addition Request:

• IL-6 Inhibitor class review - Sylvant
• Monoclonal antibody - Niktimvo

Clinical Initiative:
Midazolam Infusion in Adults
Suggested to update dosing from weight-based to non-weight based. Reduces benzodiazepine consumption in obesity.

Drug Classes Reviewed:

• Tetracyclines
• Antifungals, Azoles
• Antifungals, Echinocandins
• Activated Charcoal
• Antidote, Fomepizole
• Antipsychotic agent, Cobenfy
• Antidotes for Anticholinesterase Agents
• Antidote, Calcium trisodium pentetate
• Ophthalmic local anesthetics
• Antidote, Cyanokit, Sodium thiosulfate, and Sodium nitrite/thiosulfate
• Heavy Metal Antagonist
• Dietary Supplement, Levocarnitine

Consent Agenda (Previously Reviewed):
Consent Agenda First Group, Consent Agenda Second Group, Consent Agenda Third Group

Therapeutic Interchange (Automatic): none

Antimicrobial Stewardship:
Usage presented for LOLR, LOHH, and LOWC Campuses

Measurements:
Pain Management Trends
Quarterly BCMA Medication Scanning Rates
Medication Events

For details of the meeting, including class reviews and consent agenda, click here.

The following drug classes were reviewed:

• Antihemorrhagic Agents
  
• Non-Selective Beta-Adrenergic Agonist (12:12.08.04)
  
• Organophosphate Antidote (91:04.20) 
• Ion-Removing Agents, Other (40:18:92)  
• Antitoxins and Immune Globulins (80:04) 

Formulary Appeal Request:

• Prolaryn Gel

Formulary Addition Request:

• Axicabtagene ciloleucel (Yescarta)  
• Brexucabtagene autoleucel (Tecartus)  
• Interleukin-1 (IL-1) Inhibitor Class 
  • Anakinra – formulary 
  • Canakinumab – formulary restricted to outpatient use only 
  • Relonacept – non-formulary

• Mexthoxsalen (Uvadex) 

Consent Agenda (Previously Reviewed):

• 5-alpha Reductase Inhibitors (92:08) 
• Alpha-Adrenergic Blocking Agents (24:08.4) 
• Alpha-glucosidase inhibitors (68:20.02) 
• Angiotensin II (Giapreza)  
• Anticonvulsants Misc 2 (28:12.92)  
• Anticonvulsants Misc 3 (28:12.92) 
• Anticonvulsants Pyrrolidine (28:12.92)  
• Anticonvulsants Succinimide (28:12.20) 
• Anticonvulsants Valproates (28:12.92) 
• Antidiarrheal Agents (56:08) 
• Antivirals, topical (84:04.06) 
• Benzodiazepines (28:12:08)  
• Bile acid sequestrants (24:06.04) 
• Calcium Channel Blockers, DHP (24:28.08)  
• Calcium Channel Blockers, Non-Dihydropyridine (24:28.92) 
• Diuretics, Miscellaneous (24:08.24.92) 
• Entry Inhibitors (8:18.08) and HIV Fixed-dose Combinations (8:18.08) 
• GLP-1 Receptor Agonists  (68:20.06) 

Therapeutic Interchange (Automatic): Bile Acid Sequestrants

Antimicrobial Stewardship:

Usage presented for LOLR, LOHH, and LOWC Campuses

Measurements:

Adverse Drug Reactions presented for Jan-Mar 2025

For details of the meeting, including class reviews and consent agenda, click here

The following policies were reviewed and approved:
System P&T Committee Policy, SOP Formulary Additions to System PT, SOP Local P&T

The following drug classes were reviewed:

• Tetracyclines
• Andexanet
• Vitamin K/Phytonadione
• Acetylcysteine
• NK Antagonists

Formulary Appeal Request: none

Formulary Addition Request: none

Consent Agenda (previously reviewed):

• 4 Factor PCC (20:28.16) 
• 5-HT3 Receptor Antagonists (56:22.20) 
• ACE-Inhibitors (24:32.08) 
• Angiotensin Receptor Antagonists (24:32.08) 
• Anticonvulsants Barbiturates (28:12.04)  
• Anticonvulsants Dibenazapine (28:12.92)
• Anticonvulsants GABA (28:12.92)  
• Anticonvulsants Hydantoin (28:12.12)  
• Anticonvulsants Misc 1 (28:12.92)  
• Antigonadotropins (68:18.04)  
• Antiparkinsons agents COMT inhibitors (28:36.12)  
  
• Antiparkinsons agents Dopamine agonists (28:36.04) and (28:36.20.08)  
• Antiparkinsons agents Misc (28:92) and  (28:36.08)  
• Antiparkinsons agents MOAB inhibitors (28:36.32)  
• Aromatase Inhibitors (68:16.08)  
• Bone Resorption Inhibitors (92:24) 
• Calcitonin   
• Estrogen Receptor Antagonists/Modifiers (68:16.12)  
• Optical Imaging/Diagnostic Agent  
• Gonadotropin Releasing Hormone (GnRH) Agonists, Leuprolide (68:18.08)  
• Gonadotropin Releasing Hormone (GnRH) Agonists, Other (68:18.08)  

For details of the meeting, including class reviews and consent agendas, click here

Acadiana Market P&T - 2024

LOHH, LOWC, LOLR

December

Offsite meeting notes accessible here

October

The following policies were reviewed and approved:

The following drug classes were reviewed:

• Ophthalmic Agents: Antivirals (52:04.20) 
• Selective Beta-1-Adrenergic Agonists (12:12.08.08) 
• Direct Vasodilators (24:08.20) 
• Prokinetic Agents (56:32) Metoclopramide monograph 
• Protectants (56:28.32) sucralfate monograph 
• Sclerosing Agents (24:16, 84:04.08.20) 
• Renin Inhibitors (24:32.40)
• Otic Antimicrobials, Part 1 & 2 (52:04.04) 
• Entry and Fusion Inhibitors (8:18.08) UPDATED 
• Non-Steroidal Antiinflammatory Drugs (NSAIDs) COX-2 Selective (28:08.04.08) 
• Ophthalmic Agents: Vasoconstrictors (52:32) UPDATED 
• Ustekinumab, biosimilars (92:36) 

Formulary Appeal Request: 

• Hydroxycobalamin (Cyanokit)
• Revenfenacin (Yupelri)

Formulary Addition Request: none

• Aflibercept (Eylea)

Consent Agenda (previously reviewed):

• Antimalarial Agents (8:30.08) 
• Androgens, Part 1 (68:08) 
• Androgens, Part 2 (68:08) 
• Topical calcineurin inhibitors (84:92) - updates
• Skeletal muscle relaxants, Part 1 (12:20.04) 
• Skeletal muscle relaxants, Part 2 (12:20.12, 12:20.04, 12:20.92) 
• Direct Acting skeletal muscle relaxants (12:20.081) 
• Calcineurin inhibitor immunosuppressant agent (92:44) 
• Antineoplastic, immunosuppressant (10:00); mTOR Kinase Inhibitors (see Fyarro update) 
• Mycophenolate (92.44) 
• Hydroxyzine formulations 
• Coumarin Derivatives (20:12.04.08) 
• Direct Oral Anticoagulants
• Direct Thrombin Inhibitors (20:12.04.12) 
• LMWHs (20:12.04.16) 
• Sodium-glucose cotransporter 2 (SGLT2) Inhibitors (68:20.18) 
• Caloric Agents - Fat Emulsions 
• Appetite Stimulants 
• Anti-Sialorrhea Agents 
• Urinary anti-infectives (8:36) 
• Antifungals: Echinocandins (8:14.16) 
• Vaginal Antifungals (84:04.08.081) 
• Intravenous Steroids (68:04) 
• Oral Steroids (68:04) 
• Topical Steroids (68:04) 
• Erythropoiesis stimulating agents, biosimilars (20:16) 
• Filgrastim, biosimilars (20:16) - changes
• Pegfilgrastim, biosimilar (20:16) - changes
• Trastuzumab, biosimilars (10:00) 
• Bevacizumab, biosimilars (10:00)- changes
• Infliximab, biosimilars (92:36) - changes
• Rituximab, biosimilars (10:00) - changes

Therapeutic Interchange (Automatic) Proposals: none

Protocol Review: none

Antimicrobial Stewardship:
Metronidazole Dosing Frequency Adjustment (pharmacy driven) 
•Patients prescribed metronidazole will receive the doses every 12 hours, compared to the traditional every 8 hours 
•Pharmacokinetic and clinical outcome data support dosing every 12 hours 
•Can reduce the overall medication costs and waste for the health system. 

For details of the meeting, including class reviews and consent agendas, click here

August

The following policies were reviewed and approved:

• Pitocin Policy Approval- Oxytocin Policy represented, but it was approved at the last PT meeting but small changes were made.
• LA State Law states that Misoprostol will be a controlled medication, CIV beginning 10/1/24

The following drug classes were reviewed:

• Antigout Agents (92:16) (40:40)
• Rifamycins (8:12.28.30) (8:16.04)
• Phosphodiesterase-4 (PDE4) Inhibitors (92:36, 84:06.92, 84:92, 48:32)
• Antiparathyroid Agents (Calcimimetics) (68:24.04): 
• Antihelmintics (8:08)
• Leukotriene Modifiers (48:10.24)
• Antilipemic Agents (24:06.05) (24:06.92) 
• Antithyroid Agents (63:36.08) 
• Hepatitis C Virus (HCV) Inhibitors (8:18.40.20, 8:18.40.24, 8:18.40.16) 
• Plasma Volume Expanders (16:00, 40:12) 
• Cardiac Drugs, Misc (24:04.92) 
• Vasopressin Antagonists (40:28.28) 

Formulary Appeal Request: 
Bevacizumab (Avastin) for intralesion/intralaryngeal injections for recurrent respiratory papillomatosis; studies showing safety and effectiveness only used the branded product. Will be outpatient only for specialized ENT procedures. In-hospital using biosimilar. 

Formulary Addition Request: none

Consent Agenda (previously reviewed):

• Rabies Immune Globulin 
• RhoD Immune Globulin  
• Vitamin D analogs 
• Potassium replacement products (oral)  
• Potassium replacement products (IV)  
• First Generation Antihistamines (4:04) 
• Second Generation Antihistamines (4:08) 
• Insulins (68:20.08) 
• Probiotics  
• Progestins 
• Estrogens 
• Opiate Agonists (28:08.08) 
• Opiate Partial Agonists 

Therapeutic Interchange (Automatic) Proposals:
Phosphorus Binder Formulations
Sucroferric Oxyhydroxide (Velphoro) chewable will be switched to Renvela TID with meals

Antimicrobial Stewardship: 
Azithromycin 3-day duration (pharmacy driven)
Antibiograms Complete for 2023
1. Adult Urine/Non-Urine
2. Pediatrics Combined antibiogram
3. Trends in Susceptibility over 3 years 
Antibiotic usage was presented for LOLR, LOHH, and LOWC campuses.

For details of the meeting, including class reviews and consent agendas, click here

June

The following policies were reviewed and approved at WCH:

1) Misoprostol 
2) Oxytocin Induction

The following drug classes were reviewed:

• Polymyxins (8.12.28.28) 
• Anesthesia Gases (N/A) 
• Post-menopausal Osteoporosis Treatments, non-bisphosphonates (92:24, 24:22, 64:24.08, 68:16.12) 
• Opiate Antagonists (28:10) 
• Azole Antifungals (UPDATE) (8:14.08) 
• Amphotericin B (UPDATE) (8:14.28) 
• Guanylate Cyclase-C (GC-C) Agonists (56:92) 
• Central Alpha Agonists (24:08.16) 
• Oxytocics (76:00) (56:28.28) 
• PDE3 Inhibitors (20:12.14) (20:12.18) (24:04.08) 
• Mydriatics, Ophthalmic (52:24) 
• Dopamine (D2) Agonists, Ergot-derived (28:36.20.04) 
• Miotics, Ophthalmic (52:40.20) 
• Complement Inhibitors, C5 and C3 (92:21.08) - wording update 
  • Soliris is formulary restricted to outpatient use (not preferred) and inpatient use for atypical hemolytic uremic syndrome only. 
  • Ultomiris is formulary restricted to outpatient use only (preferred). 
  • Empaveli and Veopoz will be nonformulary.  
• Somatostatin Analogs (68:29.04) - wording update  
  • Octreotide (regular) will be formulary.  
  • Octreotide acetate LAR will be formulary-restricted to outpatient and in conjunction with Lutathera administration in same day admissions ONLY  
  • Lanreotide will be formulary-restricted to outpatient use only.  
  • Pasireotide will be non-formulary. 

Formulary Appeal Request: Advair and Symbicort at the system level, not to be affected in Acadiana. Acadiana marked will continue to use nebs, not inhalers.

Formulary Addition Request: none

Consent Agenda (previously reviewed):

• PAMORA: GI Drugs, Misc (56:92) 
• Surfactant (48:36) 
• Selective Serotonin Agonists (28:32.28) 
• Fibric Acid Derivatives (24:06.06) 
• Cephalosporins (8:12.06) 
  • Add cefpodoxime; restrict cefdinir to patients < 2 months of age. 
  • Keep ceftazidime formulary but remove restriction criteria 
• Penicillins (8:12.16) 
  • Penicillin g sodium will be formulary. 
• Aminoglycosides (8:12.02) 
• Fluoroquinolones (8:12.18) 
• Carbapenems (08:12.07.08) 
  • Remove meropenem/vaborbactam from formulary 
• Magnesium Replacement Products 
• Phosphate Binders (40.18.19) 
• Oral Iron Replacement 
  • Ferrous sulfate tablets, enteric coated tablets, and suspension oral liquid will be formulary.  
  • Ferrous sulfate extended-release tablets, ferrous gluconate, ferrous fumarate, iron polysaccharide complex, and ferric maltose will be non-formulary.  
  • For ferric citrate formulary status see Phosphate Binder Class Review. 
• SNRIs 
• SSRIs 
• 5-ASA Derivatives (56:36) 
• Prostacyclin (48:48) 
• Potassium-Removing Agents (40:18.18) 
• AntiMRSA Antibiotics (8:12.28) 
• Tetracyclines (8:12.24) 
• Monobactam (8:12.07.16) 
• Sulfonamide (8:12.20) 
• Lincosamide (8:12.28.20) 
• Antibacterials, Misc - Nitroimidazoles (8:12.28) 
• Macrolides (8:12.12) 
  

Therapeutic Interchange (Automatic) Proposals:

Inhalers to Nebs  

• Steroid/beta blocker combos -> albuterol + budesonide 
• Anticholinergic/beta bocker combos -> albuterol + ipratropium 
• Steroid/beta blocker/anticholingeric combos -> albuterol + ipratropium with budesonide 
• Long acting anticholinergics -> Ipratropium 
• Beta Blockers -> albuterol

Thiamine IV to PO per protocol 

Omnicef removal from formulary to Augmentin or Vantin 

Ophthalmic Fluoroquinolones 

• • Cipro ointment to erythromycin ointment 
  • FQ Ophthalmic solutions to Ofloxacin 

Protocol Review: none

Antimicrobial Stewardship: Review of 2024 Q1 usage at all three campuses 

For details of the meeting, including class reviews and consent agendas, click here

April

Burn Fluid Order Set was updated at MEC and taken to local P&T.

Policy PCS-378: Peripheral Parenteral Nutrition was reviewed and discussed 

The following drug classes were reviewed:

• Antidiarrheal agents 
• Alpha-glucosidase inhibitors 
• GLP-1 receptor agonists  
• Bile acid sequestrants 
• Scabicides/pediculicides 
• Barbiturates: updated to include pentobarbital 
• Nucleoside Reverse Transcriptase Inhibitors 
  • Vemlidy (tenofovir/alafenamide) added for Hep B patients 
• Alpha-adrenergic blocking agents: 
  •  Prazosin with restriction to use by psych in PTSD & nightmares 
• Protease Inhibitors: Keletra (lopinavir/ritonavir) oral solution will be restricted to peds 
• Anticonvulsants Succinimide:  Ethosuximide oral suspension will be restricted to peds. 
• Botulinum Toxins (92:92) 
• Alpha-1 Proteinase Inhibitors (48:92) 
• Asthma Biologics (48:10.20, 48:92) 
• Neuraminidase Inhibitors (8:18.28, 8:18.92) 
• Complement Inhibitors: 
  • Angioedema Treatment (92:32) 
  • Complement Inhibitors, C5 and C3 (92:21.08) 

Formulary Appeal Request: none

Formulary Addition Request: none

Consent Agenda (previously reviewed):

• Antihemorrhagic Agents: Andexxa 
• Praxbind (20:28.92) 
• Loop Diuretics (24:08.24.08) 
• Thiazide Diuretics (24:08.24.20) 
• Diuretics, misc (24:08.24.92) 
• Calcium Channel Blockers 
• Non-Dihydropyridine (24:28.92) 
• Calcium Channel Blockers, DHP (24:28.08) 
• Benzodiazepines (28:12:08) 
• Alpha-Adrenergic Blocking Agents (24:08.4) 
• 5-alpha Reductase Inhibitors (92:08) 
• Antivirals, topical (84:04.06) 
• Nucleoside Reverse Transcriptase Inhibitors (NRTIs) (8:18.08) 
• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (8:18.08) 
• Protease Inhibitors (PIs) (8:18.08) 
• Integrase Inhibitors (8:18.08) 
• Entry Inhibitors (8:18.08) 
• Fixed-dose Combinations (8:18.08) 
• Anticonvulsants Pyrrolidine (28:12.92) 
• Anticonvulsants Succinimide (28:12.20) 
• Anticonvulsants Valproates (28:12.92) 
• Anticonvulsants Misc 2 (28:12.92) 
• Anticonvulsants Misc 3 (28:12.92) 
• Angiotensin II (Giapreza) 
• Remdesivir (Veklury) 
• Rolvedon:  restricted to outpatient use only 
• Surfactants (simethicone)  
• Ophthalmic Agents: NSAIDS 
• Ophthalmic Agents:  Mast Cell Stabilizers 
• Ophthalmic Agents:  Beta Blockers  
• Ophthalmic Agents:  Prostaglandins 
• Ophthalmic Agents:  Alpha2 Agonists 
• Ophthalmic Agents: Carbonic Anhydrase Inhibitors  
• Ophthalmic Agents: Combo Products 
• Hemostatic: Factor VII (20:28.16)  
• Hemostatic: Factor VIII (20:28.16) 
• Hemostatic: Factor IX (20:28.16)  
• Hemostatic: von Willebrand Factor (20:28.16)  
• Beta Blockers (24:24)  
• Intranasal Steroids (52:08.08)  
• Inhaled Corticosteroids (68:04)  
• Selective Beta-2-Adrenergic Agonists (48:12.04.12) 
• Anticholinergic Agents (48:12.08)  

Therapeutic Interchange (Automatic) Proposals:

Kcentra to Balfaxar Conversion:  will proceed in EPIC on April 2nd, 2024 

Biosimilar Interchanges (Inpatient):   

• Avastin Interchange (to Zirabev) 
• Herceptin Interchange (to Ogivri) 
• Neulasta Interchange (to Fulphila) 
• Neupogen Interchange (to Granix) 
• Remicade Interchange (to Renflexis) 
• Rituxan Interchange (to Ruxience) 

Protocol Review: none

Antimicrobial Stewardship: CRRT/SLED Antimicrobial Dosing Guidelines

For details of the meeting, including class reviews and consent agendas, click here

February

The following was clarified: Infliximab-abda (Renflexis) will be the formulary product for inpatient use if needed . Truxima will be used instead of Rituxan.

The following drug classes were reviewed:

• 4 Factor PCC
  • Balfaxar will be formulary, replacing KCentra
• Aromatase Inhibitors
• Estrogen Receptor Antagonists
• Antigonadotropins
• Gonadotropin Releasing Hormone (GnRH) Agonists
  • Lupron Depot available via the non-formulary process for patients with Prostate Cancer with spinal metastasis 
• Gonadotropin Releasing Hormone (GnRH) Agonists, Other
• CGRP antagonists

Formulary Appeal Request:

Trihexphenidyl Liquid was approved for use in pediatrics.

Formulary Request:

Cefiderocol (Fetroja):  was presented and approved for the use in Multi-Drug Resistant Organisms with the restriction to ordering by

1. Infectious Disease Providers only

2. Critical Care providers if a facility does not have an ID provider.

Consent Agenda (previously reviewed):

• Anticonvulsants Hydantoin (28:12.12) 
• Anticonvulsants Barbiturates (28:12.04) 
• Anticonvulsants Dibenazapine (28:12.92) 
• Anticonvulsants GABA (28:12.92) 
• Anticonvulsants Misc 1 (28:12.92) 
• Antiparkinsons agents MOAB inhibitors (28:36.32) 
• Antiparkinsons agents Misc (28:92) and  (28:36.08) 
• Antiparkinsons agents COMT inhibitors (28:36.12) 
• Antiparkinsons agents Dopamine agonists (28:36.04) and (28:36.20.08) 
• Ophthalmic Antimicrobials, fluoroquinolones (52:04.04) 
• Bone Resorption Inhibitors (92:24) 
• P2Y12 Inhibitors (20:12.18) 
• Calcitonin 
• ACE-Inhibitors (24:32.04) 
• Angiotensin Receptor Antagonists (24:32.08) 
• HMG Co-A Reductase Inhibitors (24:06.06) 
• Proton-Pump Inhibitors (56:28.36) 
• 5-HT3 Receptor Antagonists (56:22.20) 
• Gleolan 

Therapeutic Interchange (Automatic) Proposals:

• Topical Antifungals
• Moduretic to Dyazide

Antimicrobial Stewardship

Antibiotic usage was presented for LOLR, LOHH, and LOWC campuses.

For details of the meeting, including class reviews and consent agendas, click here

Acadiana Market P&T - 2023

LOHH, LOWC, LOLR

December

Offsite meeting accessible here: Acadiana P&T 2023

October

Crash Cart Proposal: Update Adult Code Cart Medication list. Remove products due to low use/cost and add products actively used.

The following drug classes were reviewed:

• Vaccines, pneumococcal
• Vaccines, RSV
• Antimalarial agents, oral combinations
• Androgens, Part 1 & 2
• Topical Calcineurin Inhibitors
• Skeletal Muscle Relaxants, Part 1 & 2
• Dantrolene
• MR Contrast

Formulary Appeal Request:
Cangrelor (Kengreal) - added back for formulary but restricted to

1. Use in patients not preloaded with PO antiplatelet prior to arriving to Cath Lab
2. Use in patients experiencing cardiac arrest and cannot swallow PO antiplatelet
3. As a bridge in patients anticipated to undergo cardiac surgery (off-label use)

Formulary Addition Requests

• Rimegepant (Nurtec): calcitonin gene-related peptide indicated for migraine prevention and treatment of acute mod-severe migraine in adults; approved only if triptans are contraindicated, ineffective, or poorly tolerated.
• Human stool suspension (Rebyota): indicated for prevention of recurrence of C. difficile infection in adults following antibiotic treatment for recurrent infection. Formulary restricted to outpatient use only.
• Naltrexone ER Injection (Vivitrol): indicated for mod-severe alcohol use disorder and mild-severe opioid use disorder. Formulary restricted to outpatient use only.
• Recombinant RSV Vaccine: active immunization for the prevention of lower respiratory tract disease (LRTD) caused by RSV in persons >60 years of age; also indicated for pregnant individuals at 32-36 weeks GA to prevent LRTD caused by RSV in infants from birth through 6 months of age. Formulary restricted to outpatient use only.

Consent Agenda (previously reviewed):

• Calcineurin Inhibitor Immunosuppressive Agents
• Immunosuppressant Agents; mTOR Kinase Inhibitors
• Immunosuppressant Agents
• Antiemetic; Histamine H1 Antagonist, First Generation, Piperazine Derivate
• Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor
• Coumarin Derivatives
• Direct Oral Anticoagulants (DOAC)
• Direct Thrombin Inhibitors
• Heparins, LMWH
• Oncology Subcommittee Recommendations (Outpatient Only)
  • Elahere (mirvetuximab soravtansine)
  • Jemperli (dostarlimab-gxly)
  • Imjudo (tremelimumab-actl)
  • Mylotarg (gemtuzumab ozogamicin)
  • Tivdak (tisotumab vedotin-tftv)
  • Elzonris (tagraxofusp-erzs)
  • Margenza (margetuximab-cmkb)
  • Opdualag (nivolumab and relatlimab)
  • Rybrevant (amivantamab-vmjw)
  • Zynlonta (loncastuximab tesirine-lpyl)

Therapeutic Interchange (Automatic) Proposals:

• Galantamine ER
• Memantine ER
• Second Generation Antihistamines, Adults
• Second Generation Antihistamines with Pseudoephedrine, Adults
• Second Generation Antihistamines, Pediatrics
• Topical Azoles
• Intranasal Corticosteroids

Antimicrobial Stewardship
Adult Aminoglycoside Policy and Dosing Guidelines for FMOLHS has been revised August 2023. Healthstream education in development. Full guidelines included in packet.

Fidaxomicin (Dificid)- expanded formulary restriction to include GI in addition to ID

August

The following drug classes were reviewed:

• Alcohol withdrawal and management
• Potassium Replacements, oral
• Potassium Replacements, parenteral
• Vitamin D analogs
• Vitamins
• RhoD immune globulin
• Rabies immune globulin
• Estrogens, parts 1-3

Formulary Addition Requests

• Beyfortus (Nirsevimab)- RSV Monoclonal Antibody to be reviewed at next system P&T meeting; not yet approved

Consent Agenda (previously reviewed):

• Tacrolimus formulations
• Thyroid agents
• Overactive bladder agents
• Overactive bladder agents, misc.
• 1st generation antihistamines
• 2nd generation antihistamines
  • Formulary language clarification: loratidine formulary for adults, cetirizine formulary for pediatrics
• Sulfonylureas
• Biguanides
• Thiazolidinediones
• DDP-4 Inhibitors
• Insulins
• Opiate agonists
• Opiate partial agonists
• NSAIDs
• Analgesics/antipyretics, misc.
• Antivenin

Therapeutic Interchange (Automatic) Proposals:

• Renal Vitamins
• Seroquel XR
• Estrogens
• Famvir
• Probiotics

June

The following drug classes were reviewed:

• Magnesium replacement agents
• Iron replacement agents
• Phosphate binders
• SSRIs
• SNRIs

Formulary Addition Requests

• Minocycline PO added to formulary as a PO option (IV options are eravacycline or tigecycline for carbapenem-resistant Acinetobacter baumanii). 
• Santyl formulary restricted to inpatient burns and outpatient wound care
• Formulary language clarification
  • Bisphosphonates- Pamidronate & Zoledronic Acid (Zometa) will be formulary. Zoledronic Acid (Reclast), Ibandronate (Boniva), and Denosumab (Prolia, Xgeva) will be formulary restricted to outpatient infusion centers. Alendronate and Risedronate will be non-formulary. 
  • SGLT2 inhibitors- Dapagliflozin (Farxiga) will be formulary restricted to non-diabetic indications. Canagliflozin (Invokana), Empagliflozin (Jardiance), and Ertugliflozin (Steglatro) will be non-formulary.

Consent Agenda (previously reviewed):

• Vaxneuvance (Email vote with majority approval)
• PAMORA: GI drugs, misc
• Somatostatin anaologs
• Surfactants
• Selective serotonin agents
• Fibric Acid derivatives
• IV iron
• Cephalosporins
• Penicillins
• Aminoglycosides
• Flouroquinolones
• Carbapenems
• Monobactam
• 5-ASA derivatives
• Prostacyclin
• Potassium removing agents
• Anti-MRSA antibiotics
• Tetracyclines
• Sulfonamides
• Lincosamide
• Macrolides
• Nitroimidazole

Therapeutic Interchange (Automatic) Proposals:

• HIV combination products
• HMGCo-A reductase inhibitors
• Phosphate Binders
• Opthalmic glaucoma agents (previously reviewed; updated with apraclonidine)
• Opthalmic NSAIDs
• Opthalmic Corticosteroids
• Benzodiazepines
• Hypnotics/sedative sleep agents for ages 18-65
• Hypnotics/sedative sleep agents for ages >65 (Of note, providers will be given a choice of melatonin and trazodone as alternatives as well)
• Tramadol and tramadol combinations
• Sulfonylurea Hypoglycemics

Protocol Review - in process

1. IV to PO protocol
2. IV to PO equivalents

Antimicrobial Stewardship
Epic Antimicrobial Best Practice Advisory use is low: updates to come.
FMOLHS ASP Stewardship Initiative includes an antibiotic graded challenge, which is different from antibiotic desensitization. Providers can contact the pharmacist to order the panel.

April

The Therapeutic Marijuana Policy was updated.

The following drug classes were reviewed:

• anticonvulsants categories: misc 2, misc 3, pyrrolidine, succinamide, and valproates
• Cabenuva (for Outpatient Use; see HIV spreadsheet/monograph)
• HIV SDR INSTI+ 2 NRTIs
• HIV SDR NNRTI + 2 NRTIs
• SDR HIV other
• simethicone
• opthalmic categories: beta blockers, prostaglandins, alpha-2 agonists, carbonic anhydrase inhibitors, glaucoma combinations, mast cell stabilizers, NSAIDs

Formulary Addition Requests

• Monoferric- granted formulary status, restricted to outpatient
• Giapreza- removed from formulary
• Remdesivir- removed from formulary
• Cabenuva- restricted to outpatient
• granisetron (appeal): approved, restricted to pediatrics
• clonazepam ODT (appeal): approved, restricted to pediatric patients <50kg
• Effient (appeal): approved

Consent Agenda (previously reviewed)

• Andexxa
• Praxbind
• KCentra
• loop diuretics
• thiazide diuretics
• misc diuretics
• CCB non-DHP
• CCB-DHP
• benzodiazepines
• alpha blockers
• 5-alpha reductase inhibitors
• antivirals/topical
• hemostatics: Factors VII, IX, vWB
• beta blockers
• respiratory tract agents
• intranasal steroids
• inhaled corticosteroids
• adrenergic agents
• selective beta-2 adrenergic agonists
• anticholinergic agents

Antimicrobial Stewardship
Ceftriaxone 1gram default order button has been removed (for adults).
Epic Best Practice Advisory now live for all patients; will flag on patients with 48 hours of antibiotic use. Provider can acknowledge and give a reason with option buttons. 

February

Crash Cart Proposal: Vasopressin will be removed due to waste of high cost medication

Emergency Contraception - ACT No. 513, active 1/1/23 - approved by FMOLHS ethics. It requires a negative pregnancy test for administration for patients subjected to sexual assault only. It is stocked in Pyxis on all three Acadiana campuses.

Renal Dosing Protocol (Renal Dosing - All Meds)
Renal Dosing Protocol, antimicrobials (Renal Dosing - Antimicrobial)

The following drug classes were reviewed:

• Anti-Parkinsons agents
• Anticonvulsants
• Opthalmic antimicrobials, fluoroquinolones (updated)

Formulary Addition Requests

• Gleolan: approved, not stocked
• Omeprazole (appeal): approved, restricted for use in compounding oral suspension for neonates and shortages in pediatrics
• Indigo Carmine - not available
  • Bludigo (indigotindisulfonate sodium) - recommended replacement; not to be used with severe renal insufficiency

Consent Agenda (previously reviewed)

• Adult vaccines
• Opthalmic steroids
• Opthalmic antibiotics
• Opthalmic antihistamines
• PDE5 Inhibitors
• Bone resportion inhibitors
• P2Y12 inhibitors
• Calcitonin
• ACE-Is
• ARBs
• HMG Co-A reductase inhibitors
• Proton pump inhibitors
• 5HT3 inhibitors

Antimicrobial Stewardship 
Joint Commission/CMS requirements that hospitals implement at least two evidence-based guidelines at minimum. Market will evaluation CAP, HAP/VAP, and UTI. Market will also assess antibiotic selection and days of therapy.

Acadiana Market P&T - 2022

LOHH, LOWC, LOLR

December

The pharmacy dose rounding protocol is live for certain anti-infectives in the adult population.

ACC Campus: RSI kits will no longer contain Amiodarone. It will be in code cart.

The Mediport Flushing Process was approved by different nursing committees and presented at P&T for approval while heparin is on shortage.

Ceftazidime will be changed to cefepime for adults only.

The following drug classes were reviewed:

• melatonin antagonist/interchange 
• meningococcal vaccine
• non-barbiturate hypnotics/interchange
• CNS stimulants/interchange
• CNS stimulants (amphetamines)
• CNS stimulants (methylphenidate)
• antivirals
• antiarrythmics

Formulary Additions:

• Leqvio (inclisiran) restricted to outpatient infusion clinic)
• Xopenex (levalbuterol) restricted to neonates and shortages in pediatrics
• sufentanil added with no restrictions

Consent Agendas (previously reviewed):

• amphotericin B
• thyroid agents
• IIb/IIIa inhibitors
• thrombolytics
• antidepressants
• neuromuscular blocking agents (non-depolarizing)
• hepatitis immune globulin
• antipsychotics (LA injections, PO, and atypical)