Glucocorticoids, Oral

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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 TAPERDEX TAB DS PK Y    
dexamethasone DEXAMETHASONE TAB DS PK Y    
dexamethasone DEXAMETHASONE TABLET Y    
hydrocortisone HYDROCORTISONE TABLET Y    
hydrocortisone CORTEF TABLET Y    
methylprednisolone METHYLPREDNISOLONE TAB DS PK Y    
methylprednisolone MEDROL TAB DS PK Y    
methylprednisolone METHYLPREDNISOLONE TABLET Y    
methylprednisolone MEDROL 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 MILLIPRED TABLET N    
prednisolone sodium phosphate PEDIAPRED SOLUTION N    
prednisolone sodium phosphate PREDNISOLONE SODIUM PHOSPHATE SOLUTION N    
prednisolone sodium phosphate PREDNISOLONE SODIUM PHOS ODT TAB RAPDIS N