Corticosteroids, Inhaled
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PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | Carveout ‐ Bill FFS |
New Drug Evaluation & Updates |
|---|---|---|---|---|---|---|
| beclomethasone dipropionate | BECLOMETHASONE DIPROPIONATE | AER W/ADAP | Y | |||
| beclomethasone dipropionate | QVAR REDIHALER | HFA AEROBA | Y | |||
| budesonide | PULMICORT FLEXHALER | AER POW BA | Y | |||
| fluticasone furoate | ARNUITY ELLIPTA | BLST W/DEV | Y | |||
| fluticasone furoate | FLUTICASONE FUROATE | BLST W/DEV | Y | |||
| fluticasone propionate | FLUTICASONE PROPIONATE | BLST W/DEV | Y | |||
| mometasone furoate | ASMANEX | AER POW BA | Y | |||
| mometasone furoate | ASMANEX HFA | HFA AER AD | Y | |||
| budesonide | BUDESONIDE | AMPUL-NEB | N | Pharmacy PA | ||
| budesonide | PULMICORT | AMPUL-NEB | N | Pharmacy PA | ||
| ciclesonide | ALVESCO | HFA AER AD | N | Pharmacy PA | ||
| fluticasone propionate | ARMONAIR DIGIHALER | AER PW BAS | N | Pharmacy PA | ||
| fluticasone propionate | FLUTICASONE PROPIONATE HFA | AER W/ADAP | N | Pharmacy PA |