RAYOS (prednisone)

SELF-ADMINISTRATION - ORAL

Indications for Prior Authorization:

  • As an anti-inflammatory or immunosuppressive agent for certain allergic, dermatologic, gastrointestinal, hematologic, ophthalmologic, nervous system, renal, respiratory, rheumatologic, specific infectious diseases or conditions and organ transplantation
  • For the treatment of certain endocrine conditions
  • For palliation of certain neoplastic conditions

Patients must meet the following criteria for the indication(s) above:

  • Rayos is being used for an FDA approved indication, AND
  • The patient has tried and failed BOTH preferred generic prednisone immediate-release AND at least 1 other oral corticosteroid (chart note documentation required confirming a medically appropriate reason for preferred alternative failure)

Dosing:

  • The initial dosage of Rayos® may vary from 5 to 60 mg per day depending on the specific disease entity being treated. Patients currently on immediate release prednisone, prednisolone, or methylprednisolone should be switched to Rayos® at an equivalent dose based on relative potency.

Last review date: April 16, 2019

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