©2019 RE Pharmacy ... REMS Program: ( ) Yes ( ) No Soliris Soliris comes in … CRX-ALL-0488-20 Soliris (eculizumab) Override(s) Approval Duration *Medical PA requests are reviewed by FirstCare for in-office administration only. NOTE: The first or initial Soliris dose must be administered in a medical facility for patients who are new to therapy. Soliris REMS program to ensure that patients are counseled about the risk of meningococcal infection and receive appropriate vaccination(s) and/or drug prophylaxis prior to receiving eculizumab. • A network of 55 private ambulatory community clinics to support the administration of SOLIRIS®. Deviations in diagnosis, dosage amount, dosing interval from the initial or subsequent approvals requires prior authorization. Soliris is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). REMS requirements are an obvious challenge for health-system pharmacy. What is PALYNZIQ ® (pegvaliase-pqpz) Injection?. 1.0 Approval is dependent on the prescriber being enrolled in the SOLIRIS REMS program. Does the member have a diagnosis of Myasthenia Gravis (gMG)? This Soliris price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies. on one of the REMS medications, the pharmacy will notify you of that and often times the family already has the knowledge about the REMS program and where to obtain the medication. 1,2 Ashley N. Lewis, PharmD, BCPS, is a drug information specialist at University of North Carolina Hospitals (UNCH). Prescriber must be certified by the Soliris REMS program before prescribing. The cost for Soliris intravenous solution (10 mg/mL) is around $6,820 for a supply of 30 milliliters, depending on the pharmacy you visit. 2.0 SOLIRIS (eculizumab) coverage is limited to the approved request submitted. Enrollment in the REMS program and additional information are available by telephone. However, the REMS program represents progress toward a more thoughtful and comprehensive approach to drug safety programs enforceable by FDA. Position Statement . It is also used to treat atypical hemolytic uremic syndrome, myasthenia gravis, or neuromyelitis optica spectrum disorder.Compare monoclonal antibodies. Enrollment in the Soliris REMS program and additional information are available by telephone: 1-888-SOLIRIS (1-888-765-4747) or at www.solirisrems.com. ® in combination with Soliris (eculizumab) d. Vaccination against Neisseria meningitides prior to initiation [unless treatment cannot be delayed] ) e. Prescribing physician is enrolled in Soliris REMS program and or the Ultomiris REMS program *It is also recommended that patients receive vaccinations for pneumococcus and haemophilus Because Soliris comes with a high risk of infection, the drug is part of a Risk Evaluation and Mitigation Strategy (REMS) program. Meningococcal vaccines reduce the … Complete prescribing information is available at www.soliris.com. It may help prevent the loss of blood in patients with PNH. is a prescription medication used to lower blood levels of Phe (phenylalanine) in adults with PKU (phenylketonuria) who have uncontrolled blood Phe levels above 600 micromol/L (10 mg/dL) on their current treatment. Atypical hemolytic uremic syndrome (aHUS) a. For outpatient home administration, PA 1.0 Approval is dependent on the prescriber being enrolled in the SOLIRIS REMS program. Reference ID: 3136456 Under the Soliris REMS, prescribers must enroll in the program. . After that, subsequent doses can be home infused. While receiving eculizumab (Soliris), the member should be revaccinated according to current medical guidelines for vaccine use while on eculizumab (Soliris) therapy [REMS program]. Mail the form to Alexion Pharmaceutical, Inc. ATTN: REMS Program, 121 Seaport Boulevard, Boston, MA 02210 Fax the form to ULTOMIRIS REMS at 1-877-580-2596 Scan and email the form to rems@alexion.com Enrollment in the Soliris REMS program and additional information are available by telephone: 1-888-SOLIRIS (1-888-765-4747) or at www.solirisrems.com. ☐ ☐ Please provide documentation MYASTHENIA GRAVIS (gMG) 1. 866 413-3156 toll free phone Soliris Referral Form 877 834-1231 toll free fax QUESTIONS? Coverage is determined through a prior authorization process with supporting clinical documentation for every request. ® in combination with Soliris (eculizumab) d. Vaccination against Neisseria meningitides, pneumococcus, haemophilus and meningococcal prior to initiation [unless treatment cannot be delayed] ) e. Prescribing physician is enrolled in Soliris REMS program and or the Ultomiris REMS program 2. Soliris Prices. Under this program, prescribers must enroll in the program. The purpose of the LOTRONEX REMS Program is to inform prescribers about the risks of: To become certified in the XIAFLEX REMS Program, pharmacies and healthcare settings must complete the Pharmacy/Healthcare Setting Enrollment Form. Please contact us! called the SOLIRIS REMS. Note: While receiving eculizumab (Soliris), the member should be revaccinated according to current medical guidelines for vaccine use while on eculizumab (Soliris) therapy [REMS program] Special Notes: Criteria for Diagnosis of Severe Aplastic Anemia: The diagnostic criteria for severe aplastic anemia are: Under the Soliris REMS, prescribers must enroll in the program (1). Eculizumab is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). Soliris is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). ... Prescribers are reminded patients may choose any pharmacy of their choice. The Ambrisentan REMS is required by the Food and Drug Administration (FDA). Deviations in diagnosis, dosage amount, dosing interval from the initial or subsequent approvals requires prior authorization. PHARMACY SERVICES • Direct-to-home and clinic drug delivery services. The PALFORZIA REMS (Risk Evaluation and Mitigation Strategy) Program is a safety program that manages the risk of anaphylaxis associated with PALFORZIA TM . A REMS is a strategy to manage known or potential serious risks associated with a drug product and is required by the FDA to ensure the benefits of a drug outweigh the risks. Note: Soliris (eculizumab) is contraindicated in patients with unresolved serious Neisseria meningitidis infection. Single Shared System for Isotretinoin . III. MN-280 SOLIRIS (eculizumab) NOTE: Intolerance or previous trial/failure of traditional therapy must be must be supplied for review through physician chart note, or through patient’s pharmacy history. The PALFORZIA REMS Program is required by the Food and Drug Administration (FDA) to ensure the potential benefits of PALFORZIA outweigh its risks. Search for prescribers or healthcare facilities that are enrolled and certified in the LEMTRADA REMS and able to prescribe or dispense/administer LEMTRADA. PALYNZIQ. ECULIZUMAB is a monoclonal antibody. If a prescriber writes a new prescription for a medication that is limited under the REMS program, your Remedi SeniorCare Pharmacist will notify you of that and make Deviations in diagnosis, dosage amount, dosing interval from the initial or subsequent approvals requires prior authorization. Soliris is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). Enrollment in the Soliris REMS program and additional information are available by telephone: 1-888-SOLIRIS (1888-765-4747) or at www.solirisrems.com. REMS Certified Prescriber & Healthcare Facility Locator. II. Under the eculizumab REMS prescribers must enroll in the program. ☐ ☐ 2. Under the Soliris REMS, prescribers must enroll in the program. RISK EVALUATION AND MITIGATION STRATEGY (REMS) The iPLEDGE Program . 1 Soliris is approved to treat 2 rare conditions: paroxysmal nocturnal hemoglobinuria (type of anemia) and atypical hemolytic uremic syndrome (genetic disease with blood clots affecting vital organs). Pharmacy/Healthcare Setting Certification. This policy does not apply to health plans or member categories that do not have pharmacy benefits, nor does it apply to Medicare. Eculizumab (Soliris) is an injection that is associated with an increased risk of meningococcal disease. Policy Medications with serious safety concerns require a REMS program, and healthcare providers who prescribe these drugs often … Is the prescribing physician enrolled in Soliris® REMS program? Under the Soliris REMS, prescribers must enroll in the program. In fact, the risk is 1,000-fold to 2,000-fold among patients taking Soliris. It is used to treat a rare kind of anemia called paroxysmal nocturnal hemoglobinuria or PNH. Initial REMS Approval: 10/2010 Most Recent Modification: 04/2012 . Enrollment in the eculizumab REMS program and additional information are available by telephone: 1-888-SOLIRIS (1-888-765-4747) or at solirisrems.com . Related policies Enspryng, Ultomiris, Uplizna Policy This policy statement applies to clinical review performed for … Special Notes: Soliris is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). If the request is for Ultomiris®, has the member tried and failed Soliris®, unless contraindicated? Note that market specific restrictions or transition-of-care benefit limitations may apply. Contraindications • Soliris is only available through a REMS (Risk Evaluation and Mitigation Strategy) program due to the risk of life-threatening and fatal meningococcal infection. • In-depth knowledge of the rare disorders that SOLIRIS® treats. Before you can receive SOLIRIS, your doctor must: • enroll in the SOLIRIS REMS program • counsel you about the risk of ... meningococcal vaccinations can be given at a doctor’s office or retail pharmacy. For more information about the XIAFLEX REMS Program, call 1-877-313-1235. 2.0 SOLIRIS (eculizumab) coverage is limited to the approved request submitted. REMS are patient safety programs required by the U.S. Food and Drug Administration (FDA) that are intended to “ensure that the benefits of a drug or biological product outweigh its risks.” 1 Under the law, a REMS may be required by the FDA as part of the approval of a new product, or for an approved product when new safety information arises. Prices are for cash paying customers only and are not valid with insurance plans. • Available assistance to coordinate home infusion services. The Ambrisentan REMS is a safety program that manages the risk of serious birth defects when taking ambrisentan. 2.0 SOLIRIS (eculizumab) coverage is limited to the approved request submitted.
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