Helping Your EoE Patients Access Eohilia

As a prescriber, you know that writing a prescription for Eohilia (Budesonide oral suspension) is just the beginning. For many patients with eosinophilic esophagitis (EoE), the process of actually obtaining the medication can be lengthy, confusing, and discouraging. This guide provides a practical framework for your practice to streamline Eohilia access.

Understanding the Access Landscape

Eohilia presents unique access challenges compared to most gastroenterology medications:

• Specialty pharmacy requirement: Eohilia cannot be dispensed through retail pharmacy channels. Prescriptions must be routed to specialty pharmacies within Takeda's distribution network.
• Universal prior authorization: Virtually all commercial payers, Medicare Part D plans, and Medicaid programs require prior authorization before covering Eohilia.
• Step therapy prevalence: Many plans mandate documented failure of PPI therapy and/or dietary modification before authorizing Eohilia.
• Cost barrier: At approximately $1,930 per 30-day supply (WAC), out-of-pocket costs are prohibitive for most patients without insurance coverage or assistance programs.

Recommended Practice Workflow

Implementing a standardized workflow can significantly reduce time-to-treatment:

Step 1: Prescribe and Submit PA Simultaneously

When you determine that Eohilia is appropriate, submit the prior authorization at the same time you write the prescription. Do not wait for the specialty pharmacy to trigger the PA process — proactive submission saves 3 to 5 business days.

Step 2: Prepare Comprehensive Documentation

Your PA submission should include:

• Confirmed EoE diagnosis with biopsy results (≥15 eosinophils/hpf)
• Symptom history and severity (dysphagia episodes, food impactions, weight loss)
• Prior treatment attempts with outcomes (PPI type, dose, duration, and histologic response)
• Rationale for Eohilia over off-label alternatives (FDA-approved formulation, standardized dosing, clinical trial efficacy data)
• Letter of medical necessity — Takeda provides a template on their HCP portal

Step 3: Enroll in Head Start and Copay Programs

While the PA is processing, enroll eligible patients in Takeda's support programs:

• Head Start: One-time 30-day supply at no cost for commercially insured patients while PA is pending
• Copay Offer: Ongoing copay reduction — eligible patients may pay as little as $0 per fill (max $2,500/year)
• HELP at Hand: Patient assistance program for uninsured/underinsured patients

Enrollment can be initiated through Takeda's support line at 1-866-861-1482 or through the specialty pharmacy.

Step 4: Route the Prescription to the Right Pharmacy

Send the prescription to a specialty pharmacy that is in-network for the patient's insurance and carries Eohilia. Common options include:

• Accredo (Express Scripts)
• CVS Specialty
• AllianceRx Walgreens Specialty
• BriovaRx (UnitedHealth)
• Optum Specialty Pharmacy

Check the patient's insurance formulary to determine which specialty pharmacy is preferred or required.

Step 5: Monitor and Follow Up

Designate a staff member to track PA status and specialty pharmacy fulfillment. Key milestones to monitor:

• PA submission confirmation (Day 0)
• PA decision (typically Days 5–10)
• If denied: peer-to-peer review request (within 48 hours of denial)
• Specialty pharmacy shipment confirmation
• Patient receipt of medication

Using MedFinder for Providers

MedFinder for Providers is a free tool that helps healthcare professionals locate pharmacies with specific medications in stock. You can use it to:

• Identify specialty pharmacies carrying Eohilia near your patient's location
• Verify real-time availability before routing a prescription
• Share the tool with patients so they can check availability independently

Consider bookmarking the tool and sharing it with your patient access team.

Handling PA Denials

If the initial PA is denied, the following steps typically yield the best results:

1. Request peer-to-peer review immediately — speaking directly with the payer's medical director is often the fastest path to reversal
2. Strengthen documentation — add any missing clinical details, patient-reported outcomes, or specialist letters
3. File a formal appeal — include all prior documentation plus the denial letter and your clinical rationale
4. Engage the patient — patients can file their own appeal and contact their state insurance commissioner if the denial appears inappropriate

When to Consider Alternatives

If Eohilia access is significantly delayed (>3 weeks) and the patient needs treatment, consider initiating an alternative therapy while continuing to pursue Eohilia coverage:

• Compounded budesonide oral viscous suspension: 1 mg/5 g sucralose BID — most clinically similar to Eohilia
• Swallowed fluticasone propionate: 440–880 mcg BID from MDI
• Dupixent (dupilumab): For steroid-refractory cases or patients with comorbid atopic conditions

For a full comparison of alternatives, see our provider shortage update or direct patients to the patient alternatives guide.

Key Takeaways

• Proactive PA submission and comprehensive documentation are the most impactful steps you can take
• Takeda's Head Start and copay programs are underutilized — enroll patients at time of prescribing
• Use MedFinder for Providers to locate pharmacies with stock
• Have a backup treatment plan ready for patients who experience extended delays
• Designate a staff member to manage the specialty pharmacy workflow