Vigadrone (vigabatrin tablets and oral solution – Upsher-Smith) — Cigna

Initial criteria

• Patient age ≥ 2 years
• Patient has tried and/or is concomitantly receiving at least three other antiseizure medications
• Medication is prescribed by or in consultation with a neurologist

Reauthorization criteria

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

Approval duration

3 months initial, 1 year reauth