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Network P+T Approval Process for Remdesivir

Remdesivir patients must be 

  • Newly hospitalized patients whose most recent COVID-19 test is positive, with hypoxemia and no alternative explanation for hypoxemia 

OR 

  • Hospitalized COVID-19 patients with abrupt change in oxygen requirements, or new hypoxemia with no alternative explanation 

Remdesivir will not be given to patients  

  • With AST or ALT above 5x the upper limit of normal 
  • With eGFR < 30 mL/min or dialysis 
  • Previously administered remdesivir 
  • for more than a five-day course 
  • With later stage disease, as evidenced by ECMO/mechanical ventilation/clinical illness longer than seven days 

Notes: 

Hypoxemia is an O2 saturation < 91% on room air, or an increase in baseline oxygen to maintain O2 saturation > 91 % (ACDIS definition) 

All requests for remdesivir will be reviewed by a clinician prior to being dispensed, with weight given to inflammatory markers (lymphopenia, CRP, LDH, ferritin) and the oxygen requirement trend, as well as alternative diagnoses. 

There is no longer a requirement for pulmonary/critical care consultation for remdesivir. 

Each patient will require documentation by the physician that the patient was counseled. Physician may use the smartphrase COVIDREMDESIVIR for this purpose. Each patient must have a signed consent. 

References: 

1.https://www.covid19treatmentguidelines.nih.gov/antiviral-therapy/remdesivir/ (accessed August 5, 2020) 

Pinson, R and Tang S “CDI guide 2020” ACDIS (American Clinical Documentation Improvement Specialists) 

August 7, 2020