how does your insititution deal with IVIG?

[lorain]

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you have multiple products, some which have different indications. factor in the price, and you have a dicey situation.

has your institution game planned with respect to how you use it?

just wondering👍

 

[Its Z]

you have multiple products, some which have different indications. factor in the price, and you have a dicey situation.

has your institution game planned with respect to how you use it?

just wondering👍

Try to limit the use to outpatient where reimbursement can be more favorable compared to inpatient use and DRG payment.

Also, if your facility is 340B, you can get a major discount with certain brands.

As far as different indications, who cares...

Also a good idea to establish IVIG Use Guidelines and stick to it.

 

[ucrx]

Try to limit the use to outpatient where reimbursement can be more favorable compared to inpatient use and DRG payment.

Also, if your facility is 340B, you can get a major discount with certain brands.

As far as different indications, who cares...

Also a good idea to establish IVIG Use Guidelines and stick to it.

This is pretty much what my last hospital did.

 

[Its Z]

This is pretty much what my last hospital did.

Well, then they're such a copycat...

 

[vash1012]

My institution has requires justification for use in inpatients and has preapproved indications that it can be given for. Other than it, its really only used by outpatients.

 

[PharmDstudent]

LTAC patients are strictly inpatient, so no outpatient use for us.

We get the Carimune brand.

Have the order rounded up or down so that there is no "leftover" waste.

 

[lorain]

Try to limit the use to outpatient where reimbursement can be more favorable compared to inpatient use and DRG payment.

Also, if your facility is 340B, you can get a major discount with certain brands.

As far as different indications, who cares...

Also a good idea to establish IVIG Use Guidelines and stick to it.

thats one of the issues im seeing

we want to do a preferred contract, but at the moment are held up since gamunex is the only one approved for CIDP...if that isnt there for them, the MD will be calling about said indication and he/she would be technically right

 

[Its Z]

thats one of the issues im seeing

we want to do a preferred contract, but at the moment are held up since gamunex is the only one approved for CIDP...if that isnt there for them, the MD will be calling about said indication and he/she would be technically right

So your MDs only prescribe drugs that have an indication for particular condition?

 

[Its Z]

Your real question and the research should concentrate on how Gamunex-C is different from other IVIG.

Other than different non-therapeutic additives, I would think IVIG is an IVIG.

Let me know if I'm outdated.

 

[lorain]

So your MDs only prescribe drugs that have an indication for particular condition?

no but they get denied sometimes when they go off label

this time the md would be on label, in gamunex, and hence would have a legit case to ask to get gamunex....so for us to do a prefered formulary and contract with ivig (got a good offer on two non gamunex products) is a bit problematic at the moment since the indication on the ivig products are different and gamunex is only 1 for cidp

 

[owlegrad]

Hoote.

 

[PharmDstudent]

no but they get denied sometimes when they go off

That sounds like insurance bs. If the PPIs can be subbed for each other... I mean... doesn't everyone use pantoprazole?... then why does it matter with IVIG?

 

[lorain]

That sounds like insurance bs. If the PPIs can be subbed for each other... I mean... doesn't everyone use pantoprazole?... then why does it matter with IVIG?

like i said i think it has to do with indication here

gamunex is only 1 for cidp

we are getting good offers on 2 non gamunex products , but are getting challenged by Mds that they want gamunex b/c of said indication

 

[Its Z]

like i said i think it has to do with indication here

gamunex is only 1 for cidp

we are getting good offers on 2 non gamunex products , but are getting challenged by Mds that they want gamunex b/c of said indication

I have 100+ hospitals that use IVIG...and no one uses Gamunex.

Your pharmacy department can't convince IVIG = IVIG to a physician???

Fire the clinical manager. Now.

So do you guys make Vancomycin oral solution made with IV vanco and use it for C.Diff instead of using brand Vancocin Capsule? Does compounded Oral Vanco have the indication?

You keep going back to the "indication" but how often are drugs used off label? All the time all day long.

Ask the physician why Gamunex is different than other IVIG and why and how it's more effective?? Physician has to provide the clinical justification instead of "because it has an indication."

IVIG = IVIG.... except for some inert additive differences.

C'mon....

 

[lorain]

I have 100+ hospitals that use IVIG...and no one uses Gamunex.

Your pharmacy department can't convince IVIG = IVIG to a physician???

Fire the clinical manager. Now.

So do you guys make Vancomycin oral solution made with IV vanco and use it for C.Diff instead of using brand Vancocin Capsule? Does compounded Oral Vanco have the indication?

You keep going back to the "indication" but how often are drugs used off label? All the time all day long.

Ask the physician why Gamunex is different than other IVIG and why and how it's more effective?? Physician has to provide the clinical justification instead of "because it has an indication."

IVIG = IVIG.... except for some inert additive differences.

C'mon....

the dept had some overturn

so the people arent even in place at the moment👎

 

[Its Z]

the dept had some overturn

so the people arent even in place at the moment👎

Then take it upon yourself to do the research to prove IVIG = IVIG...and also provide the financial benefit of using the other IVIG to the physician and hospital administration.

This is your chance.

Geebus dood....even CIDP USA states IVIG = IVIG.

You can't find CIDP studies using any other IVIG instead of Gamunex?

 

[Its Z]

Abstract
Background Different preparations of intravenous immunoglobulin (IVIg) are considered to have comparable clinical efficacy but this has never been formally investigated. Some patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) report that some IVIg brands are more effective than others. A liquid IVIg preparation is more user friendly and potentially can be infused at a faster rate.

Objectives The primary objective was to compare the efficacy of two different IVIg brands in CIDP. The secondary objective was to compare their safety.

Methods This was an investigator-initiated multi-centre randomised controlled double-blind trial. Twenty-seven patients with active but stable CIDP treated with their individual stable IVIg (Gammagard S/D) maintenance dose and interval were randomised to receive four infusions of freeze-dried 5% IVIg (Gammagard S/D) or the new liquid 10% IVIg (Kiovig). The overall disability sum score (ODSS) was used as the primary outcome scale. The equivalence margin was defined as a difference of ≤1 point in mean ΔODSS between treatment groups. Main secondary outcome scales were the MRC sum score and the Vigorimeter.

Results Repeated measurements analysis of variance, adjusted for baseline ODSS, showed a clinically insignificant treatment difference of 0.004 (95% CI –0.4 to 0.4). We also found no significant differences in any of the other outcome measures. Besides a lower occurrence of cold shivers in patients randomised to Kiovig (p=0.03), no significant differences were found in the occurrence of adverse events.

Conclusions This trial demonstrated equal clinical efficacy between a freeze-dried and a liquid IVIg preparation for maintenance treatment of CIDP.

 

[lorain]

Then take it upon yourself to do the research to prove IVIG = IVIG...and also provide the financial benefit of using the other IVIG to the physician and hospital administration.

This is your chance.

Geebus dood....even CIDP USA states IVIG = IVIG.

You can't find CIDP studies using any other IVIG instead of Gamunex?

i was just assigned this

sorry boss 🙁

but i just wanted to get a feel of what other places do

 

[JackBeanstalk]

we carry carimune, gamagard, and gamunex at my hospital. I know the transplant/nephrology folks prefer gamunex/gammard because its sucrose free and better for the kidneys. I work in a government hospital where there is no insurance needed and wastage and entitlement is status quo. I've already said too much, I must go....

 

[KARM12]

We only use Gamunex-C. We don't carry any other types of IVIG.

 

[Praziquantel86]

Gamunex only, unless there's an issue with the additives. All IVIg is restricted to our formulary pager to make sure that it's actually being used appropriately.