Firdapse — CareFirst (Caremark)
Lambert-Eaton myasthenic syndrome (LEMS)
Initial criteria
- Diagnosis is confirmed by either of the following: electromyography (EMG) showing compound muscle action potential (CMAP) increased at least 2-fold after maximum voluntary contraction of the tested muscle OR a positive anti-P/Q type voltage-gated calcium channel antibody test
- Member has proximal muscle weakness
- For treatment-naïve members, the Quantitative Myasthenia Gravis (QMG) score is at least 5
- Coverage will not be provided for members with a history of seizures
Reauthorization criteria
- Member is responding to therapy (i.e., there is stability or improvement in symptoms relative to the natural course of LEMS)
Approval duration
Initial: 6 months; Reauthorization: 12 months