Eohilia — Medical Mutual

Eosinophilic Esophagitis

Initial criteria

Patient is age ≥ 11 years; AND
Patient has a diagnosis of eosinophilic esophagitis as confirmed by an endoscopic biopsy demonstrating ≥ 15 intraepithelial eosinophils per high-power field; AND
Patient has received at least 8 weeks of therapy of BOTH of the following (i and ii): i. Proton pump inhibitor; AND ii. Topical (esophageal) corticosteroid; AND
Patient meets ONE of the following (i or ii): i. Patient has tried dietary modifications to manage eosinophilic esophagitis; OR ii. The prescriber has determined that the patient is not an appropriate candidate for dietary modifications; AND
Patient meets ONE of the following (i or ii): i. Patient is currently receiving a course of Eohilia and additional medication is needed to complete a 12-week course; OR ii. Patient meets ONE of the following (a or b): a. Patient has not been treated with Eohilia within the previous 6 months; OR b. According to the prescriber, the patient is experiencing recurrent worsening dysphagia after discontinuing Eohilia therapy; AND
The medication is prescribed by or in consultation with an allergist or gastroenterologist

12 weeks