Skip to main content
. 2022 Feb 1;13(1):77–85. doi: 10.6004/jadpro.2022.13.1.7

Table 2. Belantamab Mafodotin-blmf Risk Evaluation and Mitigation Strategy (REMS): Restricted Distribution Program Requirements.

Party Action Forms for submission How often
Health-care setting • Designate authorized representative • Health-care setting enrollment form Once with enrollment
• Train staff
• Establish processes and procedures
• Obtain authorization to dispense each dose • REMS checklist Each dispense
Providers • Review prescribing information • Knowledge assessment Once with enrollment
• Review program overview and education • Prescriber enrollment form
• Complete knowledge assessment • Patient enrollment form
• Enroll as prescriber
• Counsel on ocular toxicity and ophthalmic evaluations
• Enroll patient
• Consult eye care professional • Eye care professional consult request form Each treatment
• Assess consult • Patient status form
Patients • Receive counseling • Patient enrollment form Each treatment
• Enroll
• Attend ophthalmic exams Each treatment