IMMUNOMODULATORS: ASTHMA
Displaying 1 - 5 of 5 records found.| Brand Name/Generic Name | NDC/Manufacturer | FFS Clinical Prior Auth Required | PDL Prior Auth Required | Programs |
|---|---|---|---|---|
| FASENRA PEN 30 MG/ML benralizumab |
00310183030 ASTRAZENECA |
Yes | No | Medicaid CHIP CSHCN |
| XOLAIR 150 MG/ML SYRINGE omalizumab |
50242021501 GENENTECH, INC. |
No | No | Medicaid CHIP CSHCN |
| XOLAIR 75 MG/0.5 ML SYRINGE omalizumab |
50242021401 GENENTECH, INC. |
No | No | Medicaid CHIP CSHCN |
| NUCALA 100 MG/ML AUTO-INJECTOR mepolizumab |
00173089201 GLAXOSMITHKLINE |
Yes | Yes | Medicaid CHIP CSHCN |
| NUCALA 100 MG/ML SYRINGE mepolizumab |
00173089242 GLAXOSMITHKLINE |
Yes | Yes | Medicaid CHIP CSHCN |