Eohilia (budesonide oral suspension) — United Healthcare
Eosinophilic esophagitis (EoE)
Preferred products
- Proton pump inhibitor (e.g., pantoprazole, omeprazole)
- Inhalational corticosteroid administered orally [budesonide nebulized solution (Pulmicort respules), Fluticasone HFA (Flovent HFA authorized generic)]
Initial criteria
- Diagnosis of eosinophilic esophagitis (EoE)
- Patient is experiencing symptoms related to esophageal dysfunction (e.g., dysphagia, food impaction, chest pain that is often centrally located and may not respond to antacids, gastroesophageal reflux disease-like symptoms/refractory heartburn, upper abdominal pain)
- Submission of medical records (e.g., chart notes, laboratory values, etc.) documenting eosinophil-predominant inflammation on esophageal biopsy, consisting of a peak value of ≥15 intraepithelial eosinophils per high power field (HPF)
- Secondary causes of esophageal eosinophilia have been ruled out
- History of suboptimal response, contraindication, or intolerance to an 8-week trial of both of the following: 1) Proton pump inhibitor (e.g., pantoprazole, omeprazole) AND 2) Inhalational corticosteroid administered orally [e.g., budesonide nebulized solution (Pulmicort respules), Fluticasone HFA (Flovent HFA authorized generic)]
- Prescribed by or in consultation with an Allergist/Immunologist or Gastroenterologist
Reauthorization criteria
- Documentation of positive clinical response to Eohilia therapy as evidenced by a reduction in intraepithelial eosinophils per high power field (HPF)
Approval duration
12 months