Cells of the zona fasciculata and zona reticularis lack aldosterone synthase (CYP11B2) that converts corticosterone to aldosterone, and thus these tissues produce only the weak mineralocorticoid corticosterone. However, both these zones do contain the CYP17A1 missing in zona glomerulosa and thus produce the major glucocorticoid, cortisol. Zona fasciculata and zona reticularis cells also contain CYP17A1, whose 17,20-lyase activity is responsible for producing the androgens, dehydroepiandrosterone (DHEA) and androstenedione. Thus, fasciculata and reticularis cells can make corticosteroids and the adrenal androgens, but not aldosterone.
This program divides certain therapeutic categories of drugs into two or more levels called Tiers. Tier 1 medications are preferred as the first step for treating a member’s health condition. They are cost effective and are usually available without PA. Members that do not achieve a clinical success with Tier 1 medications may qualify to obtain a Tier 2 or Tier 3 medication. Most of these categories are set up so that if a member meets the step therapy criteria, their claim for the next highest tier will process without a PA. Alternately, a PA may be required so that OHCA will have documentation of the step therapy and/or other clinical information necessary to approve the use of a Tier 2 or higher medication. Providers who have members with clinical exceptions may request a PA to skip the step therapy process and receive the Tier 2 or Tier 3 drug immediately. Please see each therapeutic category for specific clinical criteria required to bypass the step therapy protocol.
In an embryofetal development study in pregnant rabbits, beclomethasone dipropionate administration during organogenesis from gestation days 7 to 16 at subcutaneous doses equal to and greater than times the MRHDID in adults (on a mg/m 2 basis at maternal doses of mg/kg/day and higher) produced external and skeletal malformations and embryolethal effects (increased fetal resorptions). There were no effects in fetuses of pregnant rabbits administered a subcutaneous dose times the MRHDID in adults (on a mg/m 2 basis at a maternal dose of mg/kg/day).