budesonide delayed release capsule 4 mg — Blue Cross Blue Shield of Montana

Initial criteria

• Member resides in Ohio
• Plan is Fully Insured or HIM Shop (SG)
• No FDA labeled contraindications to Tarpeyo
• The patient has another FDA labeled indication OR indication supported in compendia OR prescriber submitted two peer-reviewed journal articles supporting proposed use as generally safe and effective

Approval duration

12 months