Epidiolex — Medica

Initial criteria

• Patient has a diagnosis of Dravet syndrome, Lennox-Gastaut syndrome, or Tuberous sclerosis complex
• AND has tried at least two other antiseizure medications (e.g., valproic acid, lamotrigine, topiramate, clonazepam, levetiracetam, zonisamide, Banzel, felbamate, clobazam, Fycompa, vigabatrin)
• AND the medication is prescribed by or in consultation with a neurologist

Reauthorization criteria

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

Approval duration

1 year