GLUCOCORTICOIDS: INHALED | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
ASMANEX TWISTHALER 220 MCG #14 mometasone furoate	78206011403 ORGANON LLC	Yes	No	Medicaid CHIP CSHCN
ASMANEX TWISTHALER 220 MCG #30 mometasone furoate	78206011404 ORGANON LLC	Yes	No	Medicaid CHIP CSHCN
ASMANEX TWISTHALER 220 MCG #60 mometasone furoate	78206011402 ORGANON LLC	Yes	No	Medicaid CHIP CSHCN
ASMANEX TWISTHALER 220 MCG #60 mometasone furoate	00085134102 MERCK SHARP & D	Yes	No	Medicaid CHIP CSHCN HTWPlus
ASMANEX TWISTHALR 220 MCG #120 mometasone furoate	78206011401 ORGANON LLC	Yes	No	Medicaid CHIP CSHCN
BUDESONIDE 0.25 MG/2 ML SUSP budesonide	16714001830 NORTHSTAR RX LL	Yes	No	Medicaid CHIP CSHCN
BUDESONIDE 0.25 MG/2 ML SUSP budesonide	76282064038 EXELAN PHARMACE	Yes	No	Medicaid CHIP CSHCN
BUDESONIDE 0.25 MG/2 ML SUSP budesonide	00093681555 TEVA USA	Yes	No	Medicaid CHIP CSHCN
BUDESONIDE 0.25 MG/2 ML SUSP budesonide	00093681573 TEVA USA	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUDESONIDE 0.25 MG/2 ML SUSP budesonide	47335063149 SUN PHARMA GLOB	Yes	No	Medicaid CHIP CSHCN