Since difelikefalin is a restricted formulary item at my dialysis units, I am required to reserve its use for patients who have failed antihistamines and neuroleptics. If the patient doesn't have traditional Medicare, there may be issues with difelikefalin reimbursement by Medicare Advantage and com...

Agree. This is a restricted medication and the patient needs to have failed to antihistamines and Gabapentin. Each dialysis unit has to implement protocols for its use and to implement payor approval prior to implementing its use in each patient, given the considerations above mentioned by Dr. @Wish...