WHA

Eohilia (budesonide)

Indications for Prior Authorization

Eohilia (budesonide)
  • For diagnosis of Eosinophilic Esophagitis (EoE)
    Indicated for 12 weeks of treatment in adult and pediatric patients 11 years of age and older with eosinophilic esophagitis (EoE). Limitations of Use EOHILIA has not been shown to be safe and effective for the treatment of EoE for longer than 12 weeks.

Criteria

Eohilia

Prior Authorization

Length of Approval: 12 Weeks [A]
For diagnosis of Eosinophilic Esophagitis (EoE)

  • Diagnosis of eosinophilic esophagitis (EoE)
    • AND
  • Patient has symptoms of esophageal dysfunction (e.g., dysphagia, food impaction, heartburn, abdominal pain)
    • AND
  • Patient has at least 15 intraepithelial eosinophils per high power field (HPF)
    • AND
  • Other causes of esophageal eosinophilia have been excluded
    • AND
  • Patient is 11 years of age or older
    • AND
  • Trial and failure (of a minimum 8-week duration), contraindication, or intolerance to a proton pump inhibitor (e.g., pantoprazole, omeprazole)
    • AND
  • Trial and failure (of a minimum 8-week duration), or intolerance to a topical (esophageal) corticosteroid (e.g., budesonide, fluticasone)
    • AND
  • Prescribed by or in consultation with one of the following:
    • Allergist/Immunologist
    • Gastroenterologist

  • Guideline ID
    GL-144800

  • Formulary
    Premium

  • Effective date
    May 1, 2024

  • P&T approval date
    Apr 17, 2024

P & T Revisions

2024-04-16

  1. Eohilia Prescribing Information. Takeda Pharmaceuticals America Inc. Lexington, MA 02421. February 2024.
  2. Study Details | A Study in Adolescents and Adults With Eosinophilic Esophagitis (EoE) Measuring Histologic Response and Determine if Reduction in Dysphagia is Achieved | ClinicalTrials.gov https://clinicaltrials.gov/study/NCT02605837. Accessed 8 March, 2024.
  3. Gonsalves NP, Aceves SS. Diagnosis and treatment of eosinophilic esophagitis. J Allergy Clin Immunol. 2020;145(1):1-7.
  4. Hirano I, Chan ES, Rank MA, et al. AGA Institute and the Joint Task Force on allergy-immunology practice parameters clinical guidelines for the management of eosinophilic esophagitis. Gastroenterology. 2020;158:1776-86.
  5. Dellon ES, Khoury P, Muir AB, et al. A clinical severity index for eosinophilic esophagitis: development, consensus, and future directions. Gastroenterology. 2022;1-18.
  1. EOHILIA has not been shown to be safe and effective for the treatment of EoE for longer than 12 weeks (1)
  • 2024-04-16: New program for Eohilia.