Ztalmy (ganaxolone) — Highmark
seizures associated with cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD)
Initial criteria
- age ≥ 2 years
- prescribed by or in consultation with a neurologist
- diagnosis of CDKL5 deficiency disorder confirmed by genetic testing
- therapeutic failure or intolerance to two plan-preferred antiepileptic medications
- prescriber provides documentation of baseline monthly seizure frequency
Reauthorization criteria
- prescriber provides documentation of a decrease in monthly seizure frequency compared to baseline
Approval duration
12 months