Glucocorticoids, Oral
PDL Reference Documents
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | Carveout ‐ Bill FFS |
New Drug Evaluation & Updates |
|---|---|---|---|---|---|---|
| dexamethasone | DEXAMETHASONE | SOLUTION | Y | N | ||
| dexamethasone | DEXAMETHASONE | TAB DS PK | Y | N | ||
| dexamethasone | DEXAMETHASONE | TABLET | Y | N | ||
| hydrocortisone | HYDROCORTISONE | TABLET | Y | N | ||
| methylprednisolone | METHYLPREDNISOLONE | TAB DS PK | Y | N | ||
| methylprednisolone | MEDROL | TAB DS PK | Y | N | ||
| prednisone | PREDNISONE INTENSOL | ORAL CONC | Y | N | ||
| prednisone | PREDNISONE | TAB DS PK | Y | N | ||
| budesonide | TARPEYO | CAPSULE DR | N | N | ||
| dexamethasone | HEMADY | TABLET | N | N | ||
| hydrocortisone | ALKINDI SPRINKLE | CAP SPRINK | N | N | ||
| prednisolone | PREDNISOLONE | TABLET | N | N | ||
| prednisolone sodium phosphate | PREDNISOLONE SODIUM PHOSPHATE | SOLUTION | N | N |