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Acadiana Market P&T - 2023
LOHH, LOWC, LOLR
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December
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Offsite meeting accessible here: Acadiana P&T 2023
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October
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Crash Cart Proposal: Update Adult Code Cart Medication list. Remove products due to low use/cost and add products actively used.
| Removal Recommendations |
Addition Recommendations |
| Dobutamine Premixed 800mg bags |
Amiodarone 360mg Premixed Drip |
| Lidocaine Premixed 2g bags |
Norepinephrine Premixed 8mg/250mL Drip |
| Betadine 10% 4oz bottles |
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| Cetacaine Topical Spray |
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| Digoxin 0.5mg Injection |
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| Methylprednisolone 1g vial |
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| Verapamil 5mg injection |
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| Lidocaine Jelly 2% |
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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
- Use in patients not preloaded with PO antiplatelet prior to arriving to Cath Lab
- Use in patients experiencing cardiac arrest and cannot swallow PO antiplatelet
- 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
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August
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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
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June
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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.
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April
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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.
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February
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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.
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