Fintepla — Blue Cross Blue Shield of Kansas

Initial criteria

• The prescriber is a specialist in the area of the patient's diagnosis (e.g., neurologist), or the prescriber has consulted with a specialist in the area of the patient's diagnosis
• The patient does NOT have any FDA labeled contraindications to the requested agent

Reauthorization criteria

• The patient has been previously approved for the requested agent through the plan’s Prior Authorization process
• The patient has had clinical benefit with the requested agent
• If using for seizure management associated with Dravet syndrome (DS) or Lennox-Gastaut syndrome (LGS), the requested agent will NOT be used as monotherapy
• An echocardiogram assessment will be obtained during treatment with the requested agent to evaluate for valvular heart disease and pulmonary arterial hypertension
• The prescriber is a specialist in the area of the patient’s diagnosis (e.g., neurologist), or the prescriber has consulted with a specialist in the area of the patient’s diagnosis
• The patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

12 months