UNC Health Medication Formulary
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UNC Health Medication Formulary
Change Request Form Chemical/SDS Search UNC Health.org
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delandistrogene moxeparvovec

delandistrogene moxeparvovec
Drug Name Form Strength ARHS Blue Ridge Caldwell Chatham Johnston Lenoir Medical Center Nash Pardee Rex Rockingham Southeastern Wayne Youth Behavioral Health
Elevidys (10-10.4 kg) KIT, INTRAVENOUS rokl                            
delandistrogene moxeparvovec-rokl KIT, INTRAVENOUS 1.33 × 10^13 vector genomes/mL (10 mL)                          

UNC Health 

System Formulary Restriction:

Elevidys is restricted to the following:

  • Ordered and signed by neurology attending / provider
  • Ambulatory patients only (i.e. not for non-ambulatory patients) aged 4-8 years
  • Anti-AAVrh74 antibody titer, genetic testing, and no signs of liver toxicity
    prior to administration
  • Single case agreement or financial pre-authorization approved

Caution – Category 1: Antineoplastic Hazardous Medication, see below for exposure mitigation strategies

Med Center
     UNC Medical Center Formulary Restrictions

Last updated: Aug. 24, 2026






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