Onfi — Cigna

Initial criteria

• Patient age ≥ 2 years; AND
• Patient has tried and/or is concomitantly receiving ONE of the following: (a) at least two other antiseizure medications OR (b) one of lamotrigine, topiramate, rufinamide, felbamate, Fintepla (fenfluramine oral solution), or Epidiolex (cannabidiol oral solution); AND
• Clobazam is prescribed by or in consultation with a neurologist

Reauthorization criteria

• Patient is currently receiving clobazam and is responding to therapy as determined by the prescriber (e.g., reduced seizure severity, frequency, and/or duration from baseline)

Approval duration

1 year