Firdapse (amifampridine) — Highmark

Initial criteria

• age ≥ 6 years
• Diagnosis of Lambert-Eaton myasthenic syndrome (LEMS) (ICD-10: G70.80, G70.81, G73.1) supported by one of the following:
• 1. Positive anti-P/Q type voltage-gated calcium channel (VGCC) antibody testing OR
• 2. Neurophysiology studies characteristic of LEMS (e.g., high-frequency repetitive nerve stimulation)

Reauthorization criteria

• Prescriber attests that the member has experienced positive clinical response to therapy (e.g., improved muscle strength or mobility)

Approval duration

12 months