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Epidiolex — Blue Cross Blue Shield of Alabama

Seizures associated with Tuberous sclerosis complex (TSC)

Initial criteria

  • - The patient has a diagnosis of seizures associated with ONE of the following: Lennox-Gastaut syndrome (LGS) OR Dravet syndrome (DS) OR Tuberous sclerosis complex (TSC)
  • - AND if the patient has an FDA labeled indication, then ONE of the following: The patient's age is within FDA labeling for the requested indication for the requested agent OR