Sympazan — Cigna

Initial criteria

• Patient age ≥ 2 years; AND
• Patient has tried and/or is concomitantly receiving at least two other antiseizure medications; 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