Eohilia Access Challenges: A Provider Perspective

Since its FDA approval in February 2024, Eohilia (Budesonide oral suspension, 2 mg/10 mL) has become an important treatment option for eosinophilic esophagitis (EoE) in patients aged 11 and older. However, prescribers across the country are encountering significant access barriers that affect treatment initiation and continuity.

This guide summarizes the current landscape for Eohilia access in 2026 and provides actionable strategies for navigating these challenges on behalf of your patients.

Current Supply and Availability Status

As of February 2026, Eohilia is not listed on the FDA drug shortage database. Takeda Pharmaceuticals continues to manufacture and distribute the product. However, practical access barriers persist:

• Specialty pharmacy–only distribution: Eohilia is not available through standard retail pharmacy channels. Patients must fill prescriptions through designated specialty pharmacies.
• Insurance coverage gaps: Prior authorization is required by virtually all commercial and government payers. Step therapy requirements — typically mandating a trial of PPIs or off-label topical corticosteroids — are common.
• High wholesale acquisition cost: Approximately $1,930 per 30-day supply (60 unit-dose packets), creating significant out-of-pocket burden for patients without adequate coverage.

Prior Authorization: Strategies for Success

The prior authorization process represents the most significant bottleneck for Eohilia access. The following documentation improves approval rates:

• Endoscopic findings: Include esophageal biopsy results demonstrating ≥15 eosinophils per high-power field (eos/hpf)
• Symptom documentation: Document dysphagia, food impaction history, chest pain, or other EoE-related symptoms using a validated instrument (e.g., DSQ or EEsAI-PRO) when available
• Prior treatment history: Document response (or lack thereof) to PPI therapy (minimum 8-week high-dose trial) and/or dietary elimination
• Letter of medical necessity: Explain why Eohilia's FDA-approved formulation is preferred over off-label alternatives, citing the controlled clinical data from the pivotal Phase 3 trials

Expect initial turnaround of 1 to 2 weeks. If denied, peer-to-peer review with the payer's medical director is often the most efficient path to reversal.

Takeda Support Programs for Providers

Takeda offers several programs that providers should be aware of:

• Eohilia Copay Offer: Commercially insured patients may pay as little as $0 per 30-day supply (maximum annual benefit $2,500). Not valid for government-insured patients.
• Head Start Program: Provides a one-time 30-day supply at no cost for commercially insured patients while prior authorization is pending. Takeda may notify the payer that the patient has initiated therapy.
• Patient support line: 1-866-861-1482 — assists with specialty pharmacy identification, benefits verification, and copay enrollment
• HELP at Hand (Takeda Patient Assistance): For uninsured or underinsured patients meeting income eligibility criteria

Alternative Therapies When Eohilia Is Inaccessible

When Eohilia cannot be obtained in a timely manner, evidence-based alternatives include:

Compounded Budesonide Oral Viscous Suspension

Budesonide 1 mg mixed with 5 g sucralose, administered twice daily. This off-label preparation has extensive clinical experience supporting its efficacy for EoE. Cost: approximately $30 to $100/month through compounding pharmacies.

Swallowed Fluticasone Propionate

Fluticasone 440–880 mcg from an MDI, swallowed without a spacer, twice daily. Cost: $30 to $80/month for generic formulations. Counsel patients on proper swallowing technique.

Dupixent (Dupilumab)

FDA-approved for EoE. Biologic with a different mechanism (IL-4/IL-13 blockade). May be appropriate for steroid-refractory patients. Cost: approximately $3,700/month; manufacturer copay assistance available.

PPI Therapy

High-dose PPI (e.g., omeprazole 40 mg BID) for 8 weeks as initial therapy. Approximately 30–40% of EoE patients demonstrate histologic response to PPI monotherapy.

Helping Patients Navigate Access

Consider the following workflow to optimize Eohilia access for your practice:

1. Submit prior authorization at time of prescription — don't wait for the patient to encounter a denial at the pharmacy
2. Enroll eligible patients in the Head Start program to bridge the gap during PA processing
3. Direct patients to MedFinder for Providers — a tool that helps locate pharmacies with specific medications in stock
4. Have a backup plan ready — discuss alternative therapies with the patient upfront in case Eohilia access is delayed
5. Designate staff for specialty pharmacy coordination — a dedicated patient access coordinator can significantly reduce delays

Looking Ahead

The EoE treatment landscape is evolving. As payer familiarity with Eohilia increases and formulary inclusion expands, access barriers should gradually diminish. In the interim, proactive prior authorization strategies and utilization of manufacturer support programs remain essential.

For additional provider resources, visit MedFinder for Providers. For patient-facing information on Eohilia availability, direct patients to our patient shortage update or pharmacy finder guide.