prednisone delayed-release tablet — Blue Cross Blue Shield of Illinois

Preferred products

• generic oral prednisone
• generic oral corticosteroids (e.g., dexamethasone, methylprednisolone, prednisolone)

Initial criteria

• The patient has an FDA labeled indication for the requested agent AND
• Patient’s age is within FDA labeling for the requested indication OR there is support for age-appropriate use for the requested indication AND
• ONE of the following:
• A. BOTH of the following:
• 1. Prescriber has stated or documented that the patient has stage four advanced, metastatic cancer and the requested agent is being used to treat the cancer or an associated condition AND
• 2. Use of the requested agent is consistent with best practices for treatment of stage four advanced metastatic cancer or related condition, supported by peer-reviewed evidence-based literature, and FDA approved OR
• B. The patient is currently being treated with and stable on the requested agent [chart notes required] OR
• C. The patient has tried and had an inadequate response to BOTH generic oral prednisone AND at least 1 other different generic oral corticosteroid (e.g., dexamethasone, methylprednisolone, prednisolone) [chart notes required] OR
• D. BOTH a generic oral prednisone AND at least 1 other different generic oral corticosteroid were discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse event [chart notes required] OR
• E. The patient has intolerance or hypersensitivity to BOTH generic oral prednisone AND at least 1 other different generic oral corticosteroid that is not expected to occur with the requested agent [chart notes required] OR
• F. The patient has an FDA labeled contraindication to ALL generic oral corticosteroids that is not expected to occur with the requested agent [chart notes required] OR
• G. Generic oral prednisone AND at least 1 other different generic oral corticosteroid are expected to be ineffective based on known clinical characteristics of the patient and drug; OR cause adherence barrier; OR worsen a comorbid condition; OR decrease functional ability; OR cause adverse reaction or harm [chart notes required] OR
• H. Generic oral prednisone AND at least 1 other different generic oral corticosteroid are not in the best medical interest of the patient [chart notes required] OR
• I. The patient has tried another prescription drug in the same pharmacologic class or with the same mechanism as generic oral prednisone AND at least 1 other corticosteroid and discontinued due to lack of efficacy or adverse event [chart notes required]
• The patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

12 months (BCBSIL); 6 months (all other plans)