Drug - Intranasal Corticosteroid Class
Therapeutic area - Respiratory/Asthma/COPD
Beconase AQ PA
budesonide - generic PA
flunisolide – generic PA
mometasone - generic PA
Nasacort AQ PA
Rhinocort Aqua PA
triamcinolone - generic PA
Recipient must try and fail 2 of the preferred agents after a documented trial of at least two weeks of continued, daily use of the agent.
Approval criteria - Rhinocort Aqua
Approval criteria - Nasonex
- Children through age 3
- Recipients age 4 and older must try and fail 2 of the preferred agents after a documented trial of at least two weeks of continued, daily use of the agent
Failure is defined as:
Allergic rhinitis or non-allergic vasomotor rhinitis
- No improvement in nasal allergy symptoms (e.g., sneezing, itchy nose, runny nose, congestion)
- A lack of improvement in ocular allergy symptoms is not considered failure
- No reduction in the size of the polyps
- No improvement in nasal airflow
- No improvement in nasal symptoms
For any other diagnoses, (for example sinusitis, rhinosinusitis) the patient falls out of FDA approved prescribing guidelines. PA’s will not be granted.
Expected side effects of any agent in the class are not considered failure and may include: stinging, burning, dryness, sneezing, epistaxis, bad taste, and Candida overgrowth. Counseling on proper drug administration is strongly encouraged.
PA will not be granted for:
- a dislike of the smell or formulation
- concern about a reduction in growth rate
All of the preferred agents have been studied specifically for growth markers in children and have been found to not affect growth rate.
MHCP Provider Call Center 651-431-2700 or 800-366-5411