GLUCOCORTICOIDS: ORAL | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
DEXAMETHASONE 0.5 MG/5 ML LIQ dexamethasone	00054317757 ROXANE/WEST-WAR	Yes	No	Medicaid CHIP CSHCN
DEXAMETHASONE 0.5 MG/5 ML LIQ dexamethasone	00054317763 ROXANE/WEST-WAR	Yes	No	Medicaid CHIP CSHCN
DEXAMETHASONE 0.75 MG TABLET dexamethasone	00054418025 WEST-WARD/HIKMA	Yes	No	Medicaid CHIP CSHCN KHC
DEXAMETHASONE 0.75 MG TABLET dexamethasone	72603021301 NORTHSTAR RX LL	Yes	No	Medicaid CHIP CSHCN
DEXAMETHASONE 0.75 MG TABLET dexamethasone	00054818025 ROXANE/WEST-WAR	Yes	No	Medicaid CHIP CSHCN KHC
DEXAMETHASONE 1 MG TABLET dexamethasone	00054817425 WEST-WARD/HIKMA	Yes	No	Medicaid CHIP CSHCN KHC
DEXAMETHASONE 1 MG TABLET dexamethasone	00054418125 ROXANE/WEST-WAR	Yes	No	Medicaid CHIP CSHCN KHC
DEXAMETHASONE 1.5 MG TABLET dexamethasone	72603018701 NORTHSTAR RX LL	Yes	No	Medicaid CHIP CSHCN
DEXAMETHASONE 1.5 MG TABLET dexamethasone	42195015110 XSPIRE PHARMA	Yes	No	Medicaid CHIP CSHCN
DEXAMETHASONE 1.5 MG TABLET dexamethasone	00054818125 ROXANE/WEST-WAR	Yes	No	Medicaid CHIP CSHCN KHC