The Cost Challenge: Why Providers Need to Be Proactive About Eohilia Affordability

Eohilia (Budesonide oral suspension) represents a significant advancement in the treatment of eosinophilic esophagitis (EoE) — the first FDA-approved oral therapy for patients 11 years and older. However, its price tag creates a substantial barrier to adherence and treatment completion.

At approximately $1,930 per 30-day supply (ranging from $1,927 to $2,524), the full 12-week course can cost patients upward of $5,800 to $7,500 without financial assistance. With no generic alternative available, cost is one of the primary reasons patients abandon treatment or never fill their initial prescription.

As the prescribing provider, you are uniquely positioned to help patients navigate the financial landscape before treatment begins. This guide outlines the programs, strategies, and workflows that can minimize out-of-pocket costs for your EoE patients.

Understanding the Insurance Landscape for Eohilia

Before discussing savings programs, it's important to understand the typical insurance hurdles your patients will face:

Prior Authorization

Most commercial and Medicare Part D plans require prior authorization for Eohilia. Key considerations:

• Submit PA requests proactively — ideally at the time of prescribing, not after the patient arrives at the pharmacy
• Include endoscopy reports, biopsy results showing elevated eosinophil counts (≥15 eos/hpf), and documentation of EoE diagnosis
• Note any previous treatments attempted (PPIs, dietary elimination, compounded budesonide) to satisfy step therapy requirements
• Turnaround time is typically 5 to 14 business days; plan accordingly

Step Therapy Requirements

Many payers mandate documentation of treatment failure with first-line therapies before approving Eohilia. Common requirements include:

• Trial of high-dose PPI therapy (8 weeks minimum)
• Documentation of persistent symptoms or histologic activity despite PPI therapy
• Some plans may require documentation of compounded budesonide or swallowed fluticasone trial

Maintaining thorough documentation of prior treatment trials in the patient's chart will streamline the PA process significantly.

Coverage Denials and Appeals

If a PA request is denied, consider:

• Peer-to-peer review with the payer's medical director
• Formal appeal with supporting clinical documentation
• Letters of medical necessity emphasizing FDA-approved indication, chronicity of disease, and risks of untreated EoE (stricture formation, food impaction, nutritional impact)

Takeda Savings Programs: A Complete Overview

Takeda Pharmaceuticals offers several financial support programs for Eohilia. Understanding each program's eligibility criteria and enrollment process is essential for your practice workflow.

1. Eohilia Copay Offer

This is the primary savings program for commercially insured patients:

• Eligible patients: Commercially insured (private insurance, employer-sponsored plans)
• Savings: Patients may pay as little as $0 per 30-day supply
• Maximum annual benefit: Up to $2,500
• Not eligible: Patients with government insurance (Medicare, Medicaid, Tricare, VA)
• Enrollment: Contact 1-866-861-1482 or visit the Eohilia website

For most commercially insured patients, the copay offer will cover the majority or all of their out-of-pocket cost for the 12-week treatment course.

2. Head Start Program

This program addresses the gap between prescription and insurance approval:

• Eligible patients: Commercially insured patients awaiting prior authorization
• Benefit: One-time free 30-day supply of Eohilia
• Purpose: Ensures patients can begin treatment immediately while insurance paperwork is processed
• Enrollment: Through the prescribing provider's office or the Takeda support line

This program is particularly valuable because EoE patients often wait 1 to 3 weeks for PA approval. Without Head Start, that's 1 to 3 weeks of continued symptoms and potential esophageal damage.

3. HELP at Hand Patient Assistance Program

For patients who lack adequate insurance coverage:

• Eligible patients: Uninsured or underinsured patients who meet income criteria
• Benefit: Free medication for qualifying patients
• Enrollment: Requires application through Takeda's patient assistance program
• Documentation needed: Proof of income, insurance status, and prescription

This program is critical for your uninsured patients. The application process takes time, so initiate it as early as possible.

Integrating Cost Conversations Into Your Workflow

Many providers find it challenging to discuss medication costs with patients. However, proactive cost conversations improve adherence and reduce prescription abandonment. Here's a practical workflow:

At the Time of Prescribing

1. Discuss cost upfront. Inform patients that Eohilia costs approximately $1,930/month without assistance, but savings programs are available.
2. Assess insurance type. Determine if the patient has commercial insurance, Medicare, Medicaid, or is uninsured. This determines which programs they qualify for.
3. Initiate PA immediately. Don't wait for the specialty pharmacy to start the process.
4. Enroll in the copay offer. For commercially insured patients, enrollment can happen at the point of prescribing.
5. Activate Head Start if applicable. If PA will take more than a few days, enroll the patient in Head Start so they can begin treatment.

Designate a Team Member

Consider assigning a medical assistant, nurse, or patient coordinator to manage Eohilia financial navigation. This person should:

• Handle PA submissions and track status
• Enroll patients in Takeda savings programs
• Coordinate with specialty pharmacies
• Follow up with patients who haven't filled their prescriptions

Practices that designate a specific team member for specialty pharmacy coordination report higher fill rates and better patient satisfaction.

Strategies for Government-Insured Patients

Patients on Medicare, Medicaid, Tricare, and VA benefits are not eligible for manufacturer copay cards. This creates additional challenges:

Medicare Part D Patients

• Eohilia may be covered under Medicare Part D with prior authorization
• Patients in the coverage gap ("donut hole") may face significant out-of-pocket costs
• The HELP at Hand program may be available for qualifying Medicare patients
• Extra Help/Low-Income Subsidy (LIS) programs can reduce Part D costs

Medicaid Patients

• Coverage varies by state
• Prior authorization is typically required
• Copays are usually minimal if covered
• State-specific formulary restrictions may apply

For All Government-Insured Patients

• Explore independent charitable foundations that may provide copay assistance for EoE or rare disease medications
• Contact Takeda's support line to discuss all available options
• Consider whether compounded budesonide or other alternatives may be more accessible for patients facing coverage barriers

When to Consider Alternative Therapies

If a patient cannot afford Eohilia despite available programs, discuss alternatives:

• Compounded budesonide slurry: Less expensive in many cases, though not FDA-approved for EoE. Quality and consistency vary by compounding pharmacy.
• Swallowed fluticasone: Off-label use of fluticasone MDI (swallowed rather than inhaled). Lower cost but less evidence for EoE specifically.
• Dupixent (dupilumab): FDA-approved for EoE but significantly more expensive (~$3,700/month). May be appropriate for refractory cases with separate savings programs available.
• Dietary elimination therapy: No medication cost, but requires significant patient commitment and dietitian support.

For a patient-facing overview of alternatives, refer patients to our guide on alternatives to Eohilia.

Tracking and Follow-Up

Prescription abandonment rates for specialty medications are high. To improve your patients' follow-through:

• Track prescription status. Follow up within 1 week of prescribing to confirm the specialty pharmacy has received the prescription and PA is in progress.
• Call patients who haven't filled. A brief check-in call can identify barriers (cost, pharmacy confusion, insurance issues) before the patient gives up.
• Document savings program enrollment. Note which programs each patient is enrolled in for easy reference at follow-up visits.
• Monitor adherence. At follow-up appointments, ask about medication adherence and any cost-related concerns.

Quick Reference: Eohilia Cost Resources

Provider-Specific Resources

For additional tools to support your EoE patients:

• Eohilia shortage: what providers need to know in 2026
• How to help your patients find Eohilia in stock
• MedFinder for Providers — real-time pharmacy stock lookup tool

The Bottom Line

Eohilia's clinical value is clear, but its cost can be prohibitive without proper financial navigation. By proactively discussing costs, enrolling patients in savings programs at the point of prescribing, and maintaining systematic follow-up, you can significantly improve treatment access and adherence for your EoE patients.

The difference between a patient who completes a 12-week course and one who never fills the prescription often comes down to whether someone in the provider's office took the time to navigate the financial barriers. Be that practice.