Gastroenterology - Eohilia Drug Quantity Management Policy - Per Days
Defines Cigna's quantity limits and exception criteria for Eohilia (budesonide oral suspension) unit-dose packets for members covered by Cigna-administered health benefit plans.
Policy Statement was updated to note that 'one-time' overrides are provided for 12 weeks in duration (previously 30 days).
Per Days override criteria clarified to approve an additional 180 packets (previously approved 180 packets without 'additional' language).
References to 'single-dose stick packs' were changed to 'unit-dose packets' throughout the policy.
References to number of 'packets' were changed to 'mLs'.
Coverage Criteria
Eohilia 2 mg/10 mL packets 'Per Days' Limit - Exception
Exceptions to the quantity limits listed are covered as medically necessary when the following criteria are met. Any other exception is considered not medically necessary.
The approval quantity should be the number of mLs the patient has received in the last 180 days plus 1,800 mL at retail and home delivery.
Eohilia 2 mg/10 mL packets 'Per Rx' Limit
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