Limited Coverage Drugs – Budesonide enema

Generic Name 

budesonide enema

Strength

0.02 mg/ml
Form enema

Special Authority Criteria

Approval Period

For treatment of ulcerative colitis

PLUS

treatment failure or intolerance to other commercially available rectal corticosteroid preparations.

Indefinite

 

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • None

Special Authority Request Form(s)