Sympazan — CareFirst (Caremark)
Seizures associated with Dravet syndrome
Initial criteria
- The request is for Onfi (clobazam) OR Sympazan (clobazam).
Reauthorization criteria
- The request is for Onfi (clobazam) OR Sympazan (clobazam).
- The patient has achieved and maintained positive clinical response as evidenced by reduction in frequency or duration of seizures compared with seizure activity prior to initiation of the requested drug.
Approval duration
36 months