Ztalmy (ganaxolone) — CareFirst (Caremark)
Seizures associated with cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD)
Initial criteria
- Member has a confirmed pathogenic or likely pathogenic mutation in the CDKL5 gene demonstrated by enzyme assay or genetic testing
- Medication is prescribed by or in consultation with a neurologist
- Member age ≥ 2 years
Reauthorization criteria
- Member has achieved or maintained a positive clinical response to therapy (e.g., decrease in seizures)
Approval duration
Initial: 6 months; Reauthorization: 12 months