GLUCOCORTICOIDS: ORAL | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
BUDESONIDE DR 3 MG CAPSULE budesonide	16714082901 NORTHSTAR RX LL	Yes	No	Medicaid CHIP CSHCN
BUDESONIDE DR 3 MG CAPSULE budesonide	00574985510 PADAGIS	Yes	No	Medicaid CHIP CSHCN
BUDESONIDE EC 3 MG CAPSULE budesonide	51862058001 MAYNE PHARMA IN	Yes	No	Medicaid CHIP CSHCN
BUDESONIDE EC 3 MG CAPSULE budesonide	65162077810 AMNEAL PHARMACE	Yes	No	Medicaid CHIP CSHCN HTWPlus
DEXAMETHASONE 0.5 MG TABLET dexamethasone	00054417925 ROXANE/WEST-WAR	Yes	No	Medicaid CHIP CSHCN KHC
DEXAMETHASONE 0.5 MG TABLET dexamethasone	72603021201 NORTHSTAR RX LL	Yes	No	Medicaid CHIP CSHCN
DEXAMETHASONE 0.5 MG TABLET dexamethasone	00054817925 ROXANE/WEST-WAR	Yes	No	Medicaid CHIP CSHCN KHC
DEXAMETHASONE 0.5 MG/5 ML ELX dexamethasone	62135011437 CHARTWELL RX LL	Yes	No	Medicaid CHIP CSHCN
DEXAMETHASONE 0.5 MG/5 ML ELX dexamethasone	64980050924 RISING PHARM	Yes	No	Medicaid CHIP CSHCN
DEXAMETHASONE 0.5 MG/5 ML ELX dexamethasone	54879000308 STI PHARMA, LLC	Yes	No	Medicaid CHIP CSHCN