Glucocorticoids, Oral
PDL Reference Documents
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 | New Drug Evaluation |
---|---|---|---|---|---|
cortisone acetate | CORTISONE ACETATE | TABLET | Y | ||
dexamethasone | DEXAMETHASONE INTENSOL | DROPS | Y | ||
dexamethasone | DEXAMETHASONE | ELIXIR | Y | ||
dexamethasone | DEXAMETHASONE | SOLUTION | Y | ||
dexamethasone | DEXAMETHASONE | TAB DS PK | Y | ||
dexamethasone | TAPERDEX | TAB DS PK | Y | ||
dexamethasone | DEXAMETHASONE | TABLET | Y | ||
hydrocortisone | CORTEF | TABLET | Y | ||
hydrocortisone | HYDROCORTISONE | TABLET | Y | ||
methylprednisolone | MEDROL | TAB DS PK | Y | ||
methylprednisolone | METHYLPREDNISOLONE | TAB DS PK | Y | ||
methylprednisolone | MEDROL | TABLET | Y | ||
methylprednisolone | METHYLPREDNISOLONE | TABLET | Y | ||
prednisolone | PREDNISOLONE | SOLUTION | Y | ||
prednisone | PREDNISONE INTENSOL | ORAL CONC | Y | ||
prednisone | PREDNISONE | SOLUTION | Y | ||
prednisone | PREDNISONE | TAB DS PK | Y | ||
prednisone | PREDNISONE | TABLET | Y | ||
prednisone | RAYOS | TABLET DR | Y | ||
dexamethasone | HEMADY | TABLET | N | ||
hydrocortisone | ALKINDI SPRINKLE | CAP SPRINK | N | ||
prednisolone | PREDNISOLONE | TABLET | N | ||
prednisolone sodium phosphate | PREDNISOLONE SODIUM PHOSPHATE | SOLUTION | N | ||
prednisolone sodium phosphate | PEDIAPRED | SOLUTION | N | ||
prednisolone sodium phosphate | PREDNISOLONE SODIUM PHOS ODT | TAB RAPDIS | N |